Provider Demographics
NPI:1952336687
Name:PHAM, HIEN TRUNG (DC)
Entity Type:Individual
Prefix:DR
First Name:HIEN
Middle Name:TRUNG
Last Name:PHAM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6540 STOCKTON BLVD
Mailing Address - Street 2:STE 2
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-1635
Mailing Address - Country:US
Mailing Address - Phone:916-453-8845
Mailing Address - Fax:916-453-1142
Practice Address - Street 1:6540 STOCKTON BLVD
Practice Address - Street 2:STE 2
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-1635
Practice Address - Country:US
Practice Address - Phone:916-421-5915
Practice Address - Fax:916-421-5912
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28719111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0287190Medicaid
CADC0287190Medicare ID - Type UnspecifiedCHIROPRACTOR