Individual
KEVIN PHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
500 S MAIN ST, SUITE 101, ORANGE, CA 92868-4507
(714) 836-4204
(714) 836-1809
Mailing address
500 S MAIN ST, SUITE 101, ORANGE, CA 92868-4507
(714) 836-4204
(714) 836-1809
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
A67209
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A672090
CALOPTIMA
—
Enumeration date
11/08/2006
Last updated
08/18/2008
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