Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 30504 | CA |
N | 111NR0400X | Rehabilitation Chiropractor | 30504 | CA |
NPI | 1013104595 |
---|---|
Provider Name | Hien Van Pham |
First Address | Garden Grove, CA 92843-2008 |
Second Address | Garden Grove, CA 92843-2008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2007 |
Last Update Date | 11/09/2008 |