Provider Demographics
NPI:1861761983
Name:PHAM, JULIE KIMCHI
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:KIMCHI
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 1:2107 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3976
Mailing Address - Country:US
Mailing Address - Phone:714-658-8489
Mailing Address - Fax:
Practice Address - Street 1:2107 VALLEY RD
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3976
Practice Address - Country:US
Practice Address - Phone:714-658-8489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH65296183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist