Individual
DR. KEVIN CUONG PHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
445 MINNESOTA ST STE 1500, SAINT PAUL, MN 55101-2269
(773) 588-3090
Mailing address
3620 PIERCE ST S, FARGO, ND 58104-7563
(701) 799-8063
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3514K
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3514
—
MN
Enumeration date
06/20/2017
Last updated
12/05/2018
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