Provider Demographics
NPI:1578765178
Name:PHAM, NGOC (DDS)
Entity Type:Individual
Prefix:DR
First Name:NGOC
Middle Name:
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:PO BOX 7083
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-7083
Mailing Address - Country:US
Mailing Address - Phone:760-278-1612
Mailing Address - Fax:
Practice Address - Street 1:8130 MCFADDEN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-7109
Practice Address - Country:US
Practice Address - Phone:714-718-0625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2013-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54190122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist