Organization
LIGHTHOUSE ANESTHESIA MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAM-NGUYEN THI PHAM M.D. (OWNER)
(714) 636-0343
Entity
Organization
Contact information
Practice address
12601 GARDEN GROVE BLVD, GARDEN GROVE, CA 92843-1908
(714) 537-5160
Mailing address
PO BOX 775, GARDEN GROVE, CA 92842-0775
(714) 636-0343
(714) 636-0391
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G81625
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G816250
—
CA
Enumeration date
01/25/2007
Last updated
06/27/2008
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