Provider Demographics
NPI:1588684708
Name:PHAM, HAI TAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:HAI
Middle Name:TAN
Last Name:PHAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 INTERNATIONAL BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-2986
Mailing Address - Country:US
Mailing Address - Phone:510-836-4755
Mailing Address - Fax:510-836-4755
Practice Address - Street 1:650 INTERNATIONAL BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-2986
Practice Address - Country:US
Practice Address - Phone:510-836-4755
Practice Address - Fax:510-836-4755
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA410311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice