Basic Information
| Provider Information | |||||||||
| NPI: | 1831146125 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHAM | ||||||||
| FirstName: | DANG TUAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2625 HARLEM RD | ||||||||
| Address2: | SUITE 160 | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142254031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168930333 | ||||||||
| FaxNumber: | 7168933038 | ||||||||
| Practice Location | |||||||||
| Address1: | 2625 HARLEM RD | ||||||||
| Address2: | SUITE 160 | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142254031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168930333 | ||||||||
| FaxNumber: | 7168933038 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 07/21/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 39502 | KY | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 251073-1 | NY | Y | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 4301080957 | MI | N | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.