Provider Demographics
NPI:1043449697
Name:KIMBERLY N. PHAM. DMD. INC.
Entity Type:Organization
Organization Name:KIMBERLY N. PHAM. DMD. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:N
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-305-4447
Mailing Address - Street 1:2650 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-3823
Mailing Address - Country:US
Mailing Address - Phone:714-305-4447
Mailing Address - Fax:714-808-6422
Practice Address - Street 1:50 S ANAHEIM BLVD
Practice Address - Street 2:SUITE 94
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-2931
Practice Address - Country:US
Practice Address - Phone:714-305-4447
Practice Address - Fax:714-808-6422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-03
Last Update Date:2009-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA506711223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty