Basic Information
| Provider Information | |||||||||
| NPI: | 1689647968 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PHAM | ||||||||
| FirstName: | HIEN | ||||||||
| MiddleName: | QUANG | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2021 N MACARTHUR BLVD | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750612219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722532560 | ||||||||
| FaxNumber: | 9722534218 | ||||||||
| Practice Location | |||||||||
| Address1: | 6750 N MACARTHUR BLVD | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750392875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724012802 | ||||||||
| FaxNumber: | 9724010458 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2006 | ||||||||
| LastUpdateDate: | 03/02/2017 | ||||||||
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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 | K0540 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1335754 12 | 05 | TX | MEDICAID |