Jacqueline Van Pham

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

613 Ocean Park Blvd
Santa Monica, CA 90405-3713

Phone

(206) 841-6561

NPI assigned

Feb 19, 2025

Sex

Unspecified or another gender identity

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1739923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739923200000",
    "number": "1164228490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3980 WILSHIRE BLVD APT 222",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900104214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "613 OCEAN PARK BLVD",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904053713",
            "telephone_number": "206-841-6561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAM",
        "first_name": "JACQUELINE",
        "middle_name": "VAN",
        "sole_proprietor": "NO",
        "sex": "X",
        "enumeration_date": "2025-02-19",
        "last_updated": "2025-02-19",
        "certification_date": "2025-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jolie Pfahler, MD
• Jenna Pfefferle, MA
• Lacey Rachel Pflibsen, M.D.
• Anton Nguyen Pham, DO
• Christine Pham, PHARMD
• Julia Kristina Pham, LPCC
• Kathleen Catlan Phan, O.D.
• Pharmaca Integrative Pharmacy, Inc.
• Pharmacorp, Inc
• Lori Pharris

• Behavior Technician in Santa Monica, CA
• Providers in Santa Monica, CA by specialty
• Behavior Technician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.