Provider Demographics
NPI:1548374200
Name:PHAM, TAN N (MD)
Entity type:Individual
Prefix:
First Name:TAN
Middle Name:N
Last Name:PHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6555 COYLE AVE
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-0302
Mailing Address - Country:US
Mailing Address - Phone:916-733-3333
Mailing Address - Fax:
Practice Address - Street 1:6555 COYLE AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0302
Practice Address - Country:US
Practice Address - Phone:916-733-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67089207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1721168OtherFIRST HEALTH
CA1919397OtherUNITED HEALTHCARE
CA00A670890Medicaid
CA248487OtherINTERPLAN
CA000810342959OtherPHCS
CA90115666OtherPACIFICARE
CA6974054OtherCIGNA
CA1542514OtherGREAT WEST
CA7703129OtherAETNA
CAMCMG125700OtherWESTERN HEALTH ADVANTAGE
CA074647OtherHEALTH NET
CA2262768OtherFIRST HEALTH
CAA67089OtherBLUE CROSS
CA2262768OtherFIRST HEALTH
CA1721168OtherFIRST HEALTH