Provider Demographics
NPI:1063005726
Name:PHAM, HUY (DDS)
Entity Type:Individual
Prefix:
First Name:HUY
Middle Name:
Last Name:PHAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 GRAVES AVE STE 12E
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-5015
Mailing Address - Country:US
Mailing Address - Phone:408-253-4150
Mailing Address - Fax:
Practice Address - Street 1:5150 GRAVES AVE STE 12E
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-5015
Practice Address - Country:US
Practice Address - Phone:408-253-4150
Practice Address - Fax:408-253-1979
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-13
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD1070771223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics