Individual
CONNIE PHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1190 BAKER ST STE 100, COSTA MESA, CA 92626-4105
(949) 791-3250
(949) 791-3261
Mailing address
1190 BAKER ST STE 100, COSTA MESA, CA 92626-4105
(949) 791-3250
(949) 791-3261
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20A23711
CA
207Q00000X
Family Medicine Physician
OS0021627
FL
207Q00000X
Family Medicine Physician
S1221
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
400345101
—
TX
01
—
831947
MEDICARE
—
01
—
P02284117
RR MEDICARE
—
Enumeration date
04/20/2016
Last updated
11/03/2025
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