Provider Demographics
NPI:1902986128
Name:PHAM, DIEMPHUONG NINA (MD)
Entity Type:Individual
Prefix:DR
First Name:DIEMPHUONG
Middle Name:NINA
Last Name:PHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NINA
Other - Middle Name:
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2951 CHIMNEY ROCK RD
Mailing Address - Street 2:C
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-5937
Mailing Address - Country:US
Mailing Address - Phone:713-880-1950
Mailing Address - Fax:713-880-4666
Practice Address - Street 1:2951 CHIMNEY ROCK RD
Practice Address - Street 2:C
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-5937
Practice Address - Country:US
Practice Address - Phone:713-880-1950
Practice Address - Fax:713-880-4666
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4773207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
85012NMedicare PIN