Provider Demographics
NPI:1811645294
Name:PHAM, JOHNNY CHIEU TAN (OD)
Entity type:Individual
Prefix:DR
First Name:JOHNNY CHIEU
Middle Name:TAN
Last Name:PHAM
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1300 N VERMONT AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6098
Mailing Address - Country:US
Mailing Address - Phone:323-906-6048
Mailing Address - Fax:323-644-4442
Practice Address - Street 1:9040 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-6098
Practice Address - Country:US
Practice Address - Phone:253-968-2252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CATPG35396152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist