Provider Demographics
NPI:1538283478
Name:TUAN DINH PHAM, DDS, INC
Entity Type:Organization
Organization Name:TUAN DINH PHAM, DDS, INC
Other - Org Name:ASIAN AMERICAN DENTAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CHAIRMAN OF BOARD
Authorized Official - Prefix:DR
Authorized Official - First Name:TUAN
Authorized Official - Middle Name:DINH
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-931-6979
Mailing Address - Street 1:18 SORBONNE ST.
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683
Mailing Address - Country:US
Mailing Address - Phone:714-612-0965
Mailing Address - Fax:714-379-9314
Practice Address - Street 1:17122 BEACH BLVD.
Practice Address - Street 2:SUITE 103
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647
Practice Address - Country:US
Practice Address - Phone:714-717-2806
Practice Address - Fax:714-531-4999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-18
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB-30595-01Medicaid
CAB30595-01Medicaid