Provider Demographics
NPI:1841481652
Name:PHAM JIBBEN, H. ANH (OD)
Entity type:Individual
Prefix:
First Name:H. ANH
Middle Name:
Last Name:PHAM JIBBEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ANH
Other - Middle Name:
Other - Last Name:JIBBEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:12625 N SAGUARO BLVD
Mailing Address - Street 2:#106
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-4183
Mailing Address - Country:US
Mailing Address - Phone:480-656-2111
Mailing Address - Fax:
Practice Address - Street 1:12625 N SAGUARO BLVD
Practice Address - Street 2:#106
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-4183
Practice Address - Country:US
Practice Address - Phone:480-656-2111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1466152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ161758Medicare PIN