Provider Demographics
NPI:1366014375
Name:CHIEU PHAM DENTAL CORPORATION
Entity Type:Organization
Organization Name:CHIEU PHAM DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHIEU
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-421-5437
Mailing Address - Street 1:2015 BIRCH ROAD STE 103
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915
Mailing Address - Country:US
Mailing Address - Phone:619-421-5437
Mailing Address - Fax:619-924-8494
Practice Address - Street 1:2015 BIRCH ROAD
Practice Address - Street 2:STE 103
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915
Practice Address - Country:US
Practice Address - Phone:619-421-5437
Practice Address - Fax:619-924-8494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-11
Last Update Date:2021-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty