Provider Demographics
NPI:1891723839
Name:PHAM, MINH-DUC DINH (DDS)
Entity Type:Individual
Prefix:
First Name:MINH-DUC
Middle Name:DINH
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 1:18 SORBONNE ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-8917
Mailing Address - Country:US
Mailing Address - Phone:714-271-7323
Mailing Address - Fax:714-379-9314
Practice Address - Street 1:9559 BOLSA AVE
Practice Address - Street 2:SUITE C
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5904
Practice Address - Country:US
Practice Address - Phone:714-531-0999
Practice Address - Fax:714-531-4999
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44057122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD-44057Medicaid