Provider Demographics
NPI:1134911100
Name:PHAM, HIEP NGOC (PT,DPT)
Entity type:Individual
Prefix:
First Name:HIEP
Middle Name:NGOC
Last Name:PHAM
Suffix:
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8151 INGRAM CIR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-7607
Mailing Address - Country:US
Mailing Address - Phone:714-454-9934
Mailing Address - Fax:
Practice Address - Street 1:3401 W SUNFLOWER AVE STE 200
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6945
Practice Address - Country:US
Practice Address - Phone:714-619-8766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38420225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist