Provider Demographics
NPI:1841744083
Name:PHAM, EVELYN (DDS)
Entity Type:Individual
Prefix:
First Name:EVELYN
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 1:21140 RIDGE PARK DR
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-7809
Mailing Address - Country:US
Mailing Address - Phone:714-970-6918
Mailing Address - Fax:
Practice Address - Street 1:1151 E HOLT AVE
Practice Address - Street 2:SUITE R
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-5813
Practice Address - Country:US
Practice Address - Phone:909-620-8288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100548122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist