Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 32107 | CO |
N | 2084N0400X | Neurologist | 32101 | CO |
NPI | 1083632731 |
---|---|
Provider Name | Khoi Duy Pham |
First Address | Denver, CO 80217-0326 |
Second Address | Englewood, CO 80113-2702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D17977 | (02) |