Provider Demographics
NPI:1780061358
Name:PHAM, BAO (MD)
Entity type:Individual
Prefix:
First Name:BAO
Middle Name:
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 1:1100 WARD AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1617
Mailing Address - Country:US
Mailing Address - Phone:808-544-2600
Mailing Address - Fax:808-441-1704
Practice Address - Street 1:1100 WARD AVE STE 700
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814
Practice Address - Country:US
Practice Address - Phone:808-544-2600
Practice Address - Fax:808-441-1704
Is Sole Proprietor?:No
Enumeration Date:2015-05-02
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-19779207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine