Individual
DIEMKIEU PHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2230 N RIDGE RD, WICHITA, KS 67205-1053
(316) 448-8339
(316) 221-7149
Mailing address
2230 N RIDGE RD, WICHITA, KS 67205-1053
(316) 448-8339
(316) 221-7149
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
15-02552
KS
363A00000X
Physician Assistant
Primary
15-02552
KS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/26/2021
Last updated
09/08/2022
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