Provider Demographics
NPI:1740413681
Name:PHAM, ELIZABETH THU (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:THU
Last Name:PHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 N SINGINGWOOD ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-5714
Mailing Address - Country:US
Mailing Address - Phone:714-538-1098
Mailing Address - Fax:
Practice Address - Street 1:1665 SCENIC AVE
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1445
Practice Address - Country:US
Practice Address - Phone:714-436-4775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105690207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine