Provider Demographics
NPI:1013064005
Name:NGUYEN PHAM, DIANA KIM PHUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:KIM PHUNG
Last Name:NGUYEN PHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DIANA
Other - Middle Name:KIM PHUNG
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:18642 BUSHARD ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7209
Mailing Address - Country:US
Mailing Address - Phone:714-883-0771
Mailing Address - Fax:714-962-2321
Practice Address - Street 1:18642 BUSHARD ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7209
Practice Address - Country:US
Practice Address - Phone:714-883-0771
Practice Address - Fax:714-962-2321
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83986207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine