Provider Demographics
NPI:1639955248
Name:PHAM, RYAN B (DDS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:B
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 1:4046 ABOURNE RD APT B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-3244
Mailing Address - Country:US
Mailing Address - Phone:714-225-8538
Mailing Address - Fax:
Practice Address - Street 1:4046 ABOURNE RD APT B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-3244
Practice Address - Country:US
Practice Address - Phone:714-225-8538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109318122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist