Basic Information
| Provider Information | |||||||||
| NPI: | 1356417752 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TAM NGUYEN THI PHAM MD INC | ||||||||
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| OtherOrganizationName: | LIGHTHOUSE ANESTHESIA MEDICAL GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 775 | ||||||||
| Address2: | |||||||||
| City: | GARDEN GROVE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146360342 | ||||||||
| FaxNumber: | 7146360391 | ||||||||
| Practice Location | |||||||||
| Address1: | 12900A GARDEN GROVE BLVD | ||||||||
| Address2: | STE 122 | ||||||||
| City: | GARDEN GROVE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146360342 | ||||||||
| FaxNumber: | 7146360391 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2006 | ||||||||
| LastUpdateDate: | 06/27/2008 | ||||||||
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| AuthorizedOfficialLastName: | PHAM | ||||||||
| AuthorizedOfficialFirstName: | TAM NGUYEN | ||||||||
| AuthorizedOfficialMiddleName: | THI | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7146360342 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | G81625 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 00G816250 | 05 | CA | MEDICAID | P00205661 | 01 | CA | RAILROAD MEDICARE | OTHER |