Kimberly Pham, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA65729 Issued in CA

Practice address

640 W Foothill Blvd Ste 100
Glendora, CA 91741-2456

Phone

(626) 335-4041

Fax

(626) 335-3768

NPI assigned

Feb 27, 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

Enrolled in CA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

University of Southern California Keck School of Medicine, 2024

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kimberly.pham.p157@direct.healthcarepartners.nextgenshare.com

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

• Ibrahim Hanna, M.D., Inc.

  • Internal Medicine Physician
  • Glendora, CA
  • NPI 1922316751
  Medicare reassignment NPD

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

{
    "created_epoch": "1740614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741564800000",
    "number": "1609673623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 W FOOTHILL BLVD STE 100",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917412456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 W FOOTHILL BLVD STE 100",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917412456",
            "telephone_number": "626-335-4041",
            "fax_number": "626-335-3768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAM",
        "first_name": "KIMBERLY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "X",
        "enumeration_date": "2025-02-27",
        "last_updated": "2025-03-10",
        "certification_date": "2025-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA65729",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leticia Jimenez Perez
• Maria Cristina Petersen, RN
• Thomas C Petersen, PH.D. MFT
• Letrice Pettway
• Derrick Thanh Pham, PHARM. D
• Melissa Philipson
• Phillipp Medical Group, Inc (Phillipp Allergy Medical Group)
• John Terence Phillipp, MD
• Juana Constantina Phillipp, M.D.
• Piece It Together

• Physician Assistant in Glendora, CA
• Providers in Glendora, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.