Provider Demographics
NPI:1255421335
Name:PHAM, DIEM QUYNH (DO)
Entity type:Individual
Prefix:
First Name:DIEM
Middle Name:QUYNH
Last Name:PHAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 CHINO AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1294
Mailing Address - Country:US
Mailing Address - Phone:909-313-5111
Mailing Address - Fax:909-313-0959
Practice Address - Street 1:3110 CHINO AVE STE 120
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1294
Practice Address - Country:US
Practice Address - Phone:909-313-5111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7309207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology