Provider Demographics
NPI:1255476172
Name:PHAM, LIEN NGOC (DDS)
Entity Type:Individual
Prefix:DR
First Name:LIEN
Middle Name:NGOC
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 1:750 N CAPITOL AVE
Mailing Address - Street 2:SUITE B1
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95133-1913
Mailing Address - Country:US
Mailing Address - Phone:408-254-8800
Mailing Address - Fax:408-929-2678
Practice Address - Street 1:750 N CAPITOL AVE
Practice Address - Street 2:SUITE B1
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95133-1913
Practice Address - Country:US
Practice Address - Phone:408-254-8800
Practice Address - Fax:408-929-2678
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA404831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA240483OtherDELTA DENTAL-PALMDALE
CAD40483OtherCA FAMILY HEALTH PROGRAM
CAB40483-02OtherDENTICAL-PALMDALE OFF.
CAB40483-01OtherDENTICAL-SAN JOSE OFF.