Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | E4677 | CA |
N | 222Z00000X | Podiatrist | E4677 | CA |
N | 213EP1101X | Primary Podiatric Medicine | E4677 | CA |
N | 2081S0010X | Sports Medicine | E4677 | CA |
N | 213ES0000X | Sports Medicine | E4677 | CA |
Y | 213ES0103X | Foot & Ankle Surgery | E4677 | CA |
NPI | 1598710600 |
---|---|
Provider Name | Luyen Pham |
First Address | Fountain Valley, CA 92708-6859 |
Second Address | Indio, CA 92201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 23/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V09491 | (02) | CA |