Basic Information
| Provider Information | |||||||||
| NPI: | 1730542192 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PHAM | ||||||||
| FirstName: | DAI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1680 S GARFIELD AVE STE 204 | ||||||||
| Address2: | |||||||||
| City: | ALHAMBRA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 918015413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188395200 | ||||||||
| FaxNumber: | 8188395190 | ||||||||
| Practice Location | |||||||||
| Address1: | 7761 GARDEN GROVE BLVD | ||||||||
| Address2: | |||||||||
| City: | GARDEN GROVE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928414200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148988888 | ||||||||
| FaxNumber: | 7149017580 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2016 | ||||||||
| LastUpdateDate: | 02/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | A158206 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | A158206 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.