Provider Demographics
NPI:1497723670
Name:PHAM, GIAI V (DMD)
Entity Type:Individual
Prefix:
First Name:GIAI
Middle Name:V
Last Name:PHAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7090 N CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3300
Mailing Address - Country:US
Mailing Address - Phone:559-324-9494
Mailing Address - Fax:559-324-9472
Practice Address - Street 1:7090 N CEDAR AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3300
Practice Address - Country:US
Practice Address - Phone:559-324-9494
Practice Address - Fax:559-324-9472
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA500891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice