Provider Demographics
NPI:1952880627
Name:PHAM, THO NGOC (RN)
Entity Type:Individual
Prefix:
First Name:THO
Middle Name:NGOC
Last Name:PHAM
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17155 NEWHOPE ST STE P
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4233
Mailing Address - Country:US
Mailing Address - Phone:714-757-0468
Mailing Address - Fax:
Practice Address - Street 1:17155 NEWHOPE ST STE P
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4233
Practice Address - Country:US
Practice Address - Phone:714-757-0468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA767734163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency