Provider Demographics
NPI:1467460436
Name:PHAM, TAYLOR THANH (DDS)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:THANH
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 1:7881 VALLEY VIEW ST
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1849
Mailing Address - Country:US
Mailing Address - Phone:714-739-2727
Mailing Address - Fax:714-739-2757
Practice Address - Street 1:7881 VALLEY VIEW ST
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1849
Practice Address - Country:US
Practice Address - Phone:714-739-2727
Practice Address - Fax:714-739-2757
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA434831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice