Provider Demographics
NPI:1124201496
Name:LIEN NGOC PHAM DDS
Entity Type:Organization
Organization Name:LIEN NGOC PHAM DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LIEN
Authorized Official - Middle Name:NGOC
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-254-8800
Mailing Address - Street 1:2541 E AVENUE S
Mailing Address - Street 2:SUITE B
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-6402
Mailing Address - Country:US
Mailing Address - Phone:661-274-8800
Mailing Address - Fax:
Practice Address - Street 1:2541 E AVENUE S
Practice Address - Street 2:SUITE B
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-6402
Practice Address - Country:US
Practice Address - Phone:661-274-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB40483-02OtherDENTICAL