Individual
THIEN DAN PHAT PHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1500 N RENAISSANCE BLVD NE STE C, ALBUQUERQUE, NM 87107-7002
(505) 266-5565
Mailing address
800 BRADBURY DR SE STE 116, ALBUQUERQUE, NM 87106-4310
(505) 272-1476
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA2024-0083
NM
363AM0700X
Medical Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/08/2022
Last updated
12/12/2024
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