| T K Loan Pham Md Inc | |
|
79440 Corporate Centre Dr. Ste 117 La Quinta CA 92253-7241 | |
| (760) 771-2626 | |
| (760) 771-2620 |
| Full Name | T K Loan Pham Md Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 79440 Corporate Centre Dr., La Quinta, California |
| Authorized Official Name and Position | Thi Kim Loan Pham (PRESIDENT/OWNER) |
| Authorized Official Contact | 7607712626 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| T K Loan Pham Md Inc Po Box 13550 Palm Desert CA 92255-3550 Ph: (760) 771-2626 | T K Loan Pham Md Inc 79440 Corporate Centre Dr. Ste 117 La Quinta CA 92253-7241 Ph: (760) 771-2626 |
| NPI Number | 1457597411 |
|---|---|
| Provider Enumeration Date | 12/22/2008 |
| Last Update Date | 04/01/2009 |
| Medicare PECOS PAC ID | 6002963188 |
|---|---|
| Medicare Enrollment ID | O20090407000056 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457597411 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A60749 (California) | Primary |
| Provider Name | Thi K Pham |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649217217 PECOS PAC ID: 6507872553 Enrollment ID: I20060228000380 |
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