Individual
DR. JUSTIN HUNG PHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8201 E RIVERSIDE BLVD, ROCKFORD, IL 61114-2300
(815) 971-7000
Mailing address
29624 NETWORK PL, CHICAGO, IL 60673-1296
(608) 756-6278
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
036120081
IL
2085R0202X
Diagnostic Radiology Physician
21973
MS
2085R0202X
Diagnostic Radiology Physician
Primary
A72116
CA
2085R0202X
Diagnostic Radiology Physician
MD16575
RI
2085R0202X
Diagnostic Radiology Physician
MD2007-0239
NM
2085R0202X
Diagnostic Radiology Physician
P3059
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A711260
BLUE SHIELD
—
05
—
00A711260
—
CA
05
—
102062266 0001
—
PA
05
—
102062266 0005
—
PA
05
—
2927677
—
OH
05
—
7100056140
—
KY
Enumeration date
05/17/2006
Last updated
01/13/2026
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