Individual
KENNY PHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11420 WARNER AVE, FOUNTAIN VALLEY, CA 92708-2529
(657) 205-0455
Mailing address
11420 WARNER AVE, FOUNTAIN VALLEY, CA 92708-2529
(657) 205-0455
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
53710
CA
Other
Enumeration date
02/04/2026
Last updated
02/04/2026
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