Basic Information
| Provider Information | |||||||||
| NPI: | 1801449616 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHAM | ||||||||
| FirstName: | JUDY | ||||||||
| MiddleName: | HA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13210 E JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482152704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3133353444 | ||||||||
| FaxNumber: | 3134844998 | ||||||||
| Practice Location | |||||||||
| Address1: | 13210 E JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482152704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3133353444 | ||||||||
| FaxNumber: | 3134844998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2019 | ||||||||
| LastUpdateDate: | 10/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301507866 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.