Provider Demographics
NPI:1154456721
Name:PHAM, HOP NGOC (DMD)
Entity Type:Individual
Prefix:DR
First Name:HOP
Middle Name:NGOC
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 1:149 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-5302
Mailing Address - Country:US
Mailing Address - Phone:408-945-9752
Mailing Address - Fax:408-745-9872
Practice Address - Street 1:149 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-5302
Practice Address - Country:US
Practice Address - Phone:408-945-9752
Practice Address - Fax:408-745-9872
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA529141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice