Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 29948 | CA |
NPI | 1003888603 |
---|---|
Provider Name | Mr. Christopher De Pham |
First Address | Santa Clara, CA 95051 |
Second Address | Santa Clara, CA 95051 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2006 |
Last Update Date | 08/07/2007 |