Provider Demographics
NPI:1528111259
Name:PHAM, MINH THI (OD)
Entity type:Individual
Prefix:
First Name:MINH
Middle Name:THI
Last Name:PHAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12247 YEARLING PL
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-7658
Mailing Address - Country:US
Mailing Address - Phone:562-865-7350
Mailing Address - Fax:
Practice Address - Street 1:1600 S AZUSA AVE
Practice Address - Street 2:UNIT 527 PUENTE HILLS MALL
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91748-1674
Practice Address - Country:US
Practice Address - Phone:626-581-7259
Practice Address - Fax:626-581-7289
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11386T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist