Individual
THONG DIEP PHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
301 EAST MUHAMMAD ALI BOULEVARD, LOUISVILLE, KY 40201
(502) 852-5466
Mailing address
P.O. BOX 909, LOUISVILLE, KY 40201
(502) 588-0328
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
4301107533
MI
2084N0400X
Neurology Physician
Primary
01080039A
IN
2084N0400X
Neurology Physician
49356
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201384630
—
IN
05
—
7100427880
—
KY
Enumeration date
07/17/2011
Last updated
05/18/2020
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