Provider Demographics
NPI:1528197142
Name:PHAM, VAN B
Entity Type:Individual
Prefix:DR
First Name:VAN
Middle Name:B
Last Name:PHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7210 CAMINO ARROYO
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-7311
Mailing Address - Country:US
Mailing Address - Phone:408-842-1100
Mailing Address - Fax:
Practice Address - Street 1:7210 CAMINO ARROYO
Practice Address - Street 2:SUITE 106
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-7311
Practice Address - Country:US
Practice Address - Phone:408-842-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA549201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice