Provider Demographics
NPI:1649621335
Name:PHAM, XUAN (MD)
Entity type:Individual
Prefix:DR
First Name:XUAN
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TRUDY
Other - Middle Name:
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5821 JAMESON CT
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-0820
Mailing Address - Country:US
Mailing Address - Phone:916-486-0411
Mailing Address - Fax:916-486-0946
Practice Address - Street 1:5821 JAMESON CT
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0820
Practice Address - Country:US
Practice Address - Phone:916-486-0411
Practice Address - Fax:916-486-0946
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA170010207VG0400X
MI4301110538207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology