Provider Demographics
NPI:1255531687
Name:PHAM, MAILAN DINH (MD)
Entity type:Individual
Prefix:DR
First Name:MAILAN
Middle Name:DINH
Last Name:PHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:400 N. PEPPER AVE
Mailing Address - Street 2:ARMC BEHAVIORAL HEALTH
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324
Mailing Address - Country:US
Mailing Address - Phone:909-580-3830
Mailing Address - Fax:909-580-2165
Practice Address - Street 1:400 N. PEPPER AVE
Practice Address - Street 2:ARMC BEHAVIORAL HEALTH
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324
Practice Address - Country:US
Practice Address - Phone:909-580-3830
Practice Address - Fax:909-580-2165
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA959852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE502592OtherLOS ANGELES COUNTY DEPART