Provider Demographics
NPI:1508206079
Name:PHAM, THIEN-KIM THI (DDS)
Entity Type:Individual
Prefix:DR
First Name:THIEN-KIM
Middle Name:THI
Last Name:PHAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2508 GULF FWY S
Mailing Address - Street 2:STE 108
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-6743
Mailing Address - Country:US
Mailing Address - Phone:281-678-8344
Mailing Address - Fax:866-245-0553
Practice Address - Street 1:2508 GULF FWY S STE 108
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-6743
Practice Address - Country:US
Practice Address - Phone:281-678-8344
Practice Address - Fax:866-245-0553
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX291341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice