Kelly T Pham

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY29070 Issued in CA

Practice address

1015 12TH St Ste 2
Modesto, CA 95354-0838

Phone

(209) 496-2327

NPI assigned

Jul 27, 2010

Last updated

Jan 22, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Department of State Hospitals

  dba Coalinga State Hospital

  • Psychiatric Hospital
  • Coalinga, CA
  • NPI 1124078704
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1280188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674345600000",
    "number": "1114231669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 12TH ST STE 2",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953540838",
            "telephone_number": "209-496-2327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 12TH ST STE 2",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953540838",
            "telephone_number": "209-496-2327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAM",
        "first_name": "KELLY",
        "middle_name": "T",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-07-27",
        "last_updated": "2023-01-22",
        "certification_date": "2023-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY29070",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ruth Ethel Pflueger, NP, PA
• Cameron Pfohl, B.A.
• Cory Hoang Pham, MD
• Don Pham
• Flora Pham
• Liza Marie Patawaran Pham, MD
• Luyen D Pham, MD
• Michael Pham
• Patrick Khoa Pham
• Phuc Thien Pham

• Clinical Psychologist in Modesto, CA
• Providers in Modesto, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.