Provider Demographics
NPI:1336744416
Name:PHAM, JOHN DANG KHOA NGUYEN
Entity Type:Individual
Prefix:
First Name:JOHN DANG KHOA
Middle Name:NGUYEN
Last Name:PHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 BALL RD
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-3856
Mailing Address - Country:US
Mailing Address - Phone:714-484-3502
Mailing Address - Fax:
Practice Address - Street 1:5501 BALL RD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-3856
Practice Address - Country:US
Practice Address - Phone:714-484-3502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy