Provider Demographics
NPI:1750765574
Name:PHAM, TIFFANY THUY
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:THUY
Last Name:PHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:THUY
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2760 CASTLETON DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-3508
Mailing Address - Country:US
Mailing Address - Phone:408-681-9334
Mailing Address - Fax:
Practice Address - Street 1:3081 TEAGARDEN ST
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-5720
Practice Address - Country:US
Practice Address - Phone:510-347-4620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program