Basic Information
| Provider Information | |||||||||
| NPI: | 1548374200 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHAM | ||||||||
| FirstName: | TAN | ||||||||
| MiddleName: | N. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6555 COYLE AVE | ||||||||
| Address2: | |||||||||
| City: | CARMICHAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956080302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167333333 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6555 COYLE AVE | ||||||||
| Address2: | |||||||||
| City: | CARMICHAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956080302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167333333 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2006 | ||||||||
| LastUpdateDate: | 12/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A67089 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1721168 | 01 | CA | FIRST HEALTH | OTHER | 1919397 | 01 | CA | UNITED HEALTHCARE | OTHER | 00A670890 | 05 | CA | MEDICAID | 248487 | 01 | CA | INTERPLAN | OTHER | 000810342959 | 01 | CA | PHCS | OTHER | 90115666 | 01 | CA | PACIFICARE | OTHER | 6974054 | 01 | CA | CIGNA | OTHER | 1542514 | 01 | CA | GREAT WEST | OTHER | 7703129 | 01 | CA | AETNA | OTHER | MCMG125700 | 01 | CA | WESTERN HEALTH ADVANTAGE | OTHER | 074647 | 01 | CA | HEALTH NET | OTHER | 2262768 | 01 | CA | FIRST HEALTH | OTHER | A67089 | 01 | CA | BLUE CROSS | OTHER |