# PHUOC NGOC PHAM

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1376175430
- **Gender:** Man

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WP0808X | Psychiatric/Mental Health Registered Nurse | 95237355 | CA | Yes |
| 164W00000X | Licensed Practical Nurse | 697311 | CA | — |

## Other

- **Enumeration date:** 02/06/2020
- **Last updated:** 07/11/2025