Provider Demographics
NPI:1134638885
Name:PHAM, UYEN PHUONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:UYEN
Middle Name:PHUONG
Last Name:PHAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8162 MAJOR CIR APT D
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-6063
Mailing Address - Country:US
Mailing Address - Phone:714-386-0843
Mailing Address - Fax:
Practice Address - Street 1:3410 GRAND AVE STE F
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1473
Practice Address - Country:US
Practice Address - Phone:909-364-0027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS102001122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist