Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | E4417 | CA |
NPI | 1104929140 |
---|---|
Provider Name | Dr. John Pham |
First Address | Loma Linda, CA 92357-1000 |
Second Address | Loma Linda, CA 92357-1000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 30/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U0911 | (02) | CA |