1639341498 NPI number — VANG THI PHAM OD

Table of content: VANG THI PHAM OD (NPI 1639341498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639341498 NPI number — VANG THI PHAM OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHAM
Provider First Name:
VANG
Provider Middle Name:
THI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639341498
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
602 ROYAL OAKS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRIENDSWOOD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77546-7006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-814-2344
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20131 HIGHWAY 59 N STE 1140
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMBLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77338-2331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-540-7040
Provider Business Practice Location Address Fax Number:
281-540-7042
Provider Enumeration Date:
04/01/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  6971T , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)