Provider Demographics
NPI:1356933451
Name:PHAM, DANIEL CHUONG
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:CHUONG
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 1:3720 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-3135
Mailing Address - Country:US
Mailing Address - Phone:409-548-5700
Mailing Address - Fax:
Practice Address - Street 1:4930 GULFWAY DR
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-1722
Practice Address - Country:US
Practice Address - Phone:409-982-1654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician