Provider Demographics
NPI:1306032164
Name:NGHIA MINH PHAM, A PROFESSIONAL DENTAL CORP.
Entity Type:Organization
Organization Name:NGHIA MINH PHAM, A PROFESSIONAL DENTAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT DESK
Authorized Official - Prefix:MS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TSAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-547-9393
Mailing Address - Street 1:9831 MIRA MESA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1005
Mailing Address - Country:US
Mailing Address - Phone:858-547-9393
Mailing Address - Fax:858-547-9392
Practice Address - Street 1:9831 MIRA MESA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1005
Practice Address - Country:US
Practice Address - Phone:858-547-9393
Practice Address - Fax:858-547-9392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39868261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental