Provider Demographics
NPI:1619230026
Name:PHAM, NGAN KIM
Entity type:Individual
Prefix:MS
First Name:NGAN
Middle Name:KIM
Last Name:PHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14541 BROOKHURST ST
Mailing Address - Street 2:SUITE C12
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5700
Mailing Address - Country:US
Mailing Address - Phone:714-640-3430
Mailing Address - Fax:
Practice Address - Street 1:14541 BROOKHURST ST
Practice Address - Street 2:SUITE C12
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5700
Practice Address - Country:US
Practice Address - Phone:714-640-3430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker