Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | G41378 | CA |
NPI | 1003054610 |
---|---|
Provider Name | Doanh Pham |
First Address | Westminster, CA 92683-5788 |
Second Address | Westminster, CA 92683-5788 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2009 |
Last Update Date | 04/02/2009 |