# CEDAR RIDGE CLINIC,P.C.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366754202
- **Authorized official:** DR. TRUNG H PHAM D.O. (PHYSICIAN)
- **Authorized official phone:** (918) 459-0583

## Contact information

- **Practice address:** 10016 S MINGO RD STE A, TULSA, OK 74133-5789
- **Practice address phone:** (918) 459-0583
- **Practice address fax:** (918) 250-0120
- **Mailing address:** 10016 S MINGO RD STE A, TULSA, OK 74133-5789
- **Mailing address phone:** (918) 459-0583
- **Mailing address fax:** (918) 250-0120

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 3313 | OK | Yes |

## Other

- **Enumeration date:** 07/08/2010
- **Last updated:** 11/23/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100223040F | — | OK |