Provider Demographics
NPI:1356131288
Name:PHAM, KEVIN MINH (NP)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:MINH
Last Name:PHAM
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 N TUSTIN ST # 1158
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-3902
Mailing Address - Country:US
Mailing Address - Phone:714-280-2898
Mailing Address - Fax:
Practice Address - Street 1:2050 N TUSTIN ST # 1158
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-3902
Practice Address - Country:US
Practice Address - Phone:714-280-2898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95033863363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health