Individual
ETHAN PHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1030 E GUADALUPE RD, TEMPE, AZ 85283-3044
(480) 491-1898
Mailing address
2722 N 7TH ST UNIT 8, PHOENIX, AZ 85006-1067
(714) 908-6037
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
07/12/2022
Last updated
12/08/2023
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