Organization
INTERNATIONAL PEDIATRIC MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AN TAN PHAM MD (MD)
(510) 208-3540
Entity
Organization
Contact information
Practice address
600 INTERNATIONAL BLVD, #102, OAKLAND, CA 94606
(510) 208-3540
(510) 208-3553
Mailing address
600 INTERNATIONAL BLVD, #102, OAKLAND, CA 94606
(510) 208-3540
(510) 208-3553
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
A67904
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A679040
MEDI CAL
CA
Enumeration date
09/21/2006
Last updated
08/22/2020
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