MYCHELLE N. PHAM (NPI# 1770679508) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770679508 |
| Entity Type | Individual |
| Full Name | MYCHELLE N. PHAM |
| Credential | M.D. |
| Practice Address |
455 S Main St Orange CA 92868-3835 |
| Practice Telephone | 7145328620 |
| Practice Fax Number | 7142894072 |
| Mailing Telephone | 7142894511 |
| Mailing Fax Number | 7142043212 |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2020-06-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | A81905 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 00A819050 | 05 | |
| CA | MEDICARE GRP | W16177 | 01 |
| CA | MEDICARE GRP | HW16177 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2212 E 4th St Ste 201, Santa Ana, CA 927053872 | 7142883230 | |
| 5630 E Santa Ana Canyon Rd Ste 100, Anaheim, CA 928073122 | 7142576170 |
| Street Address |
455 S MAIN ST |
| City | ORANGE |
| State | CA |
| Zip Code | 92868-3835 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033191473 | Nancy Ann Varni | Nurse Practitioner | 455 S Main St, Orange, CA 92868-3835 | 2005-11-18 |
| 1265776587 | Victor Wang | Pediatrics | 455 S Main St, Orange, CA 92868-3835 | 2012-11-27 |
| 1487906152 | Nancy Kuntz | Nurse Practitioner | 455 S Main St, Orange, CA 92868-3835 | 2012-10-05 |
| 1023360914 | Youngeun Park | Pediatrics | 455 S Main St, Orange, CA 92868-3835 | 2012-10-03 |
| 1295085918 | Stacey Jannette Bass | Nurse Practitioner | 455 S Main St, Orange, CA 92868-3835 | 2012-09-11 |
| 1003165267 | Jennifer Michelle Shively | Nurse Practitioner | 455 S Main St, Orange, CA 92868-3835 | 2012-09-04 |
| 1437406014 | Heidi Rens | Pharmacist | 455 S Main St, Orange, CA 92868-3835 | 2012-08-13 |
| 1992065361 | Jina Lim | Pediatrics | 455 S Main St, Orange, CA 92868-3835 | 2012-05-20 |
| 1386901700 | Elizabeth Marie Torok | Nurse Practitioner | 455 S Main St, Orange, CA 92868-3835 | 2012-04-23 |
| 1942578117 | Cassandra Lynn Stewart | Pediatrics | 455 S Main St, Orange, CA 92868-3835 | 2011-12-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346859386 | Sadaf Abrishami | Pharmacist | 101 The City Dr S., Orange, CA 92868 | 2020-07-27 |
| 1245869825 | Helena Yijia Hong | Student in an Organized Health Care Education/Training Program | Uci Medical Center, 101 The City Drive, Orange, CA 92868 | 2020-04-06 |
| 1932736527 | Joshua Kristopher Livingston | Student in an Organized Health Care Education/Training Program | 101 The City Dr S, Rte. 128-01, Orange, CA 92868 | 2020-03-24 |
| 1831725894 | Michelle Brown | Student in an Organized Health Care Education/Training Program | 101 The City Dr S. Rte 128-01, Orange, CA 92868 | 2020-03-20 |
| 1093363491 | Kristin Lee | Pharmacist | 132 S. Anita Dr., Orange, CA 92868 | 2019-08-28 |
| 1740834217 | Matthew Brian Mecheal | Dentist | 725 W. La Veta Suite 260, Orange, CA 92868 | 2019-08-01 |
| 1245897990 | Brent Tyler Louie | Student in an Organized Health Care Education/Training Program | 101 The City Drive South Building 3, Route 88, Neuropsychiatric Center Uc Irvine Medical Center, Orange, CA 92868 | 2019-05-28 |
| 1093277972 | Danielle Amato | Student in an Organized Health Care Education/Training Program | Uc Irvine Health 101 The City Drive, City Tower, Ste 40, Orange, CA 92868 | 2019-04-01 |
| 1851852206 | Julia Ting Bu | Student in an Organized Health Care Education/Training Program | Uc Irvine Health, 101 The City Drive, City Tower, Ste 400, Orange, CA 92868 | 2019-03-28 |
| 1326507344 | Harrison Beene Lowder | Student in an Organized Health Care Education/Training Program | 505 S. Main St, Suite 525, Orange, CA 92868 | 2019-03-19 |
| Find all providers in zip 92868 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881056349 | Vivian Chima Ogueli | Pediatrics | 1120 W La Veta Ave Ste 450, Orange, CA 92868-4224 | 2016-03-24 |
| 1326428970 | Chris Tenore | Pediatrics | 1202 West La Veta Ave, Orange, CA 92868-3874 | 2015-06-08 |
| 1811375280 | Grace Mark Dasovich | Pediatrics | 505 S Main St Ste 505, Orange, CA 92868-4509 | 2015-05-18 |
| 1750786323 | Venessa Ferragamo Gutierrez | Pediatrics | 2720 E Walnut Ave, Unit 51, Orange, CA 92867-7388 | 2014-10-25 |
| 1063839934 | Raymundo Miguel Garcia Lora | Pediatrics | 1920 E Katella Ave Ste P, Orange, CA 92867-5150 | 2014-03-27 |
| 1588949887 | Linda Evelyn Mendoza | Pediatrics | 810 W Collins Ave, Orange, CA 92867-5516 | 2011-10-18 |
| 1720300239 | Meera Tejura Shah | Pediatrics | 101 The City Drive, Zot 4482, Orange, CA 92868 | 2010-02-25 |
| 1699002550 | Nwando Uchenna Eze | Pediatrics | 455 S. Main Street, Department of Pediatrics, Orange, CA 92868-3874 | 2009-11-12 |
| 1235366337 | Jennifer Green Lusk | Pediatrics | 1201 W, La Veta, Orange, CA 92868 | 2009-06-16 |
| 1265676555 | Sean Henry Vigil | Pediatrics | 333 City Boulevard West Suite 800, Uci Gme, Orange, CA 92868-0000 | 2009-04-30 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.