Individual
MR. TAI D PHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA 689
NV
363AM0700X
Medical Physician Assistant
Primary
PA0325
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100506022
—
NV
01
—
Q40842
BC
NV
Enumeration date
01/20/2006
Last updated
10/15/2018
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