Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 61817 | CA |
Y | 213EG0000X | General Practice | 61817 | CA |
NPI | 1003102336 |
---|---|
Provider Name | Dr. Peter Pham |
First Address | Fountain Valley, CA 92708-7261 |
Second Address | Downey, CA 90242-2658 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2011 |
Last Update Date | 01/06/2015 |