Provider Demographics
NPI:1881406759
Name:PHAM, LOUIS DAC (DNAP)
Entity type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:DAC
Last Name:PHAM
Suffix:
Gender:M
Credentials:DNAP
Other - Prefix:MR
Other - First Name:KHUE
Other - Middle Name:DAC DOAN
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 PROSPECT AVE
Mailing Address - Street 2:STE 2703
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1915
Mailing Address - Country:US
Mailing Address - Phone:551-996-2419
Mailing Address - Fax:
Practice Address - Street 1:30 PROSPECT AVE STE 2703
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1915
Practice Address - Country:US
Practice Address - Phone:551-996-2419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15298900367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered