Provider Demographics
NPI:1710016464
Name:LAN NGOC PHAM, DDS, INC
Entity Type:Organization
Organization Name:LAN NGOC PHAM, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-893-6768
Mailing Address - Street 1:14044 MAGNOLIA ST
Mailing Address - Street 2:SUITE 125
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-4700
Mailing Address - Country:US
Mailing Address - Phone:714-893-6768
Mailing Address - Fax:949-717-6820
Practice Address - Street 1:14044 MAGNOLIA ST
Practice Address - Street 2:SUITE 125
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-4700
Practice Address - Country:US
Practice Address - Phone:714-893-6768
Practice Address - Fax:949-717-6820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA368201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty