Provider Demographics
NPI:1972531705
Name:PHAM, THERESA THIEN-HOANG (MD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:THIEN-HOANG
Last Name:PHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 27337
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755
Mailing Address - Country:US
Mailing Address - Phone:512-775-9877
Mailing Address - Fax:512-476-9892
Practice Address - Street 1:6521 LADERA NORTE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78755
Practice Address - Country:US
Practice Address - Phone:512-755-9877
Practice Address - Fax:512-476-9892
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7832207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX191785801OtherGRP TPI #
TX045086803Medicaid
TX045086803Medicaid