Basic Information
| Provider Information | |||||||||
| NPI: | 1922462845 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHAM | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | DANG | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 840 TOWNE CENTER DR | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917675900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095051078 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9616 ARCHIBALD AVE STE 140 | ||||||||
| Address2: | |||||||||
| City: | RANCHO CUCAMONGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917307939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094810436 | ||||||||
| FaxNumber: | 9094810457 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2016 | ||||||||
| LastUpdateDate: | 06/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | DO034915 | DC | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207WX0110X | 20A19100 | CA | N | 207W00000X | 20A19100 | CA | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.