Basic Information
| Provider Information | |||||||||
| NPI: | 1609436138 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PHAM | ||||||||
| FirstName: | PHUNG | ||||||||
| MiddleName: | KIM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10007 BLISSFULL VALLEY LN | ||||||||
| Address2: | |||||||||
| City: | TOMBALL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773751018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8327663250 | ||||||||
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| Practice Location | |||||||||
| Address1: | 13480 VETERANS MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770141696 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2815871600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2019 | ||||||||
| LastUpdateDate: | 06/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP141772 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.