NPIMap

Organization Active NPI

Kevin Pham, M.D., Inc

  • Nephrology Physician
  • Orange, CA
National Provider Identifier
1578740775
Registry record updated Jan 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
A67209 Issued in CA
Legal business name
KEVIN PHAM, M.D., INC
Practice address
500 S Main St Ste 101
Orange, CA 92868-4535
Phone
(714) 836-4204
Fax
(714) 836-1809
NPI assigned
Jan 30, 2008
Last updated
Jan 30, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2008

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

Authorized official

Name
Kevin Pham, M.D.NPI 1477623635
Title
President
Phone
(714) 836-4204

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X A67209 CA Primary

Addresses

Primary practice location

500 S Main St Ste 101
Orange, CA 92868-4535

Mailing address

500 S Main St Ste 101
Orange, CA 92868-4535
Phone (714) 836-4204

Other identifiers 1

IdentifierTypeStateIssuer
00A672090OtherCAMEDICAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040721001554 CA Part B Supplier - Clinic/Group Practice 3375523277 Receives reassigned benefits from 8 practitioners
Practice locations: Costa Mesa, CA; Orange, CA

National Provider Directory

National Provider Directory

Locations

500 S Main St
Ste 101
Orange, CA 92868
Phone (714) 602-7805

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1201651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201651200000",
    "number": "1578740775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 S MAIN ST STE 101",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928684535",
            "telephone_number": "714-836-4204",
            "fax_number": "714-836-1809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 S MAIN ST STE 101",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928684535",
            "telephone_number": "714-836-4204",
            "fax_number": "714-836-1809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEVIN PHAM, M.D., INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-30",
        "last_updated": "2008-01-30",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-836-4204",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A67209",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL",
            "identifier": "00A672090",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.