Provider Demographics
NPI:1053498410
Name:PHAM, NGHIA DINH (DMD)
Entity Type:Individual
Prefix:DR
First Name:NGHIA
Middle Name:DINH
Last Name:PHAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14115 GOLDENWEST ST STE A
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-3790
Mailing Address - Country:US
Mailing Address - Phone:714-889-1263
Mailing Address - Fax:
Practice Address - Street 1:14115 GOLDENWEST ST STE A
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-3790
Practice Address - Country:US
Practice Address - Phone:714-889-1263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA521011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1053498410Medicaid
CA1053498410OtherNPI
CA1053498410Medicare NSC
CA1053498410OtherNPI
CA1053498410Medicare Oscar/Certification
CA1053498410Medicare UPIN