Provider Demographics
NPI:1134163793
Name:PHAM, TUAN A (MD)
Entity type:Individual
Prefix:
First Name:TUAN
Middle Name:A
Last Name:PHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:9333 BASELINE RD
Mailing Address - Street 2:STE. 160
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-1354
Mailing Address - Country:US
Mailing Address - Phone:909-941-4777
Mailing Address - Fax:909-941-4599
Practice Address - Street 1:9333 BASELINE RD
Practice Address - Street 2:STE. 160
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-1354
Practice Address - Country:US
Practice Address - Phone:909-941-4777
Practice Address - Fax:909-941-4599
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2015-03-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA62514207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACN226AMedicare UPIN
CAH45524Medicare UPIN