Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 48979 | CA |
Y | 213EG0000X | General Practice | 48979 | CA |
NPI | 1003900705 |
---|---|
Provider Name | Dr. Kevin Thang Pham I |
First Address | Stockton, CA 95210-4234 |
Second Address | Stockton, CA 95210-4234 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 25/03/2021 |