Provider Demographics
NPI:1235268640
Name:PHAM, HANH MY (DDS)
Entity Type:Individual
Prefix:
First Name:HANH
Middle Name:MY
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 1:12307 POWAY RD
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-4245
Mailing Address - Country:US
Mailing Address - Phone:858-668-3390
Mailing Address - Fax:
Practice Address - Street 1:12307 POWAY RD
Practice Address - Street 2:STE B
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-4245
Practice Address - Country:US
Practice Address - Phone:858-668-3390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA417711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice