International Pediatric Medical Group Inc

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A67904 Issued in CA

Legal business name

INTERNATIONAL PEDIATRIC MEDICAL GROUP INC

Practice address

600 International Blvd
#102
Oakland, CA 94606

Phone

(510) 208-3540

Fax

(510) 208-3553

NPI assigned

Sep 21, 2006

Organization subpart

No

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

Authorized official

Name

An Tan Pham, MDNPI 1205996048

Title

MD

Phone

(510) 208-3540

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• An T Pham, MD

  • Pediatrics Physician
  • Oakland, CA
  • NPI 1205996048
  NPD (past) Authorized official

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1861591752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 INTERNATIONAL BLVD",
            "address_2": "#102",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "94606",
            "telephone_number": "510-208-3540",
            "fax_number": "510-208-3553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 INTERNATIONAL BLVD",
            "address_2": "#102",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "94606",
            "telephone_number": "510-208-3540",
            "fax_number": "510-208-3553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNATIONAL PEDIATRIC MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "AN",
        "authorized_official_middle_name": "TAN",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "510-208-3540",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A67904",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI CAL",
            "identifier": "00A679040",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pediatrics Physician in Oakland, CA
• Providers in Oakland, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.