Provider Demographics
NPI:1770535841
Name:D Q PHAM MEDICAL CORPORATION
Entity type:Organization
Organization Name:D Q PHAM MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF DQ PHAM MEDICAL CORPOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DIEU
Authorized Official - Middle Name:QUY
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-534-6911
Mailing Address - Street 1:14160 BROOKHURST ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4657
Mailing Address - Country:US
Mailing Address - Phone:714-534-6911
Mailing Address - Fax:714-534-0852
Practice Address - Street 1:14160 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4657
Practice Address - Country:US
Practice Address - Phone:714-534-6911
Practice Address - Fax:714-534-0852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37427208100000X, 208D00000X
CAA62320207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0094890Medicaid
W15953Medicare ID - Type Unspecified