Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 954 | MN |
NPI | 1043553787 |
---|---|
Provider Name | Jackie Pham |
First Address | Minneapolis, MN 55407-1321 |
Second Address | Edina, MN 55435-5924 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2013 |
Last Update Date | 11/03/2021 |