Provider Demographics
NPI:1922122373
Name:PHAM, KIM THANH THI (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:THANH THI
Last Name:PHAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:KIMTHANH
Other - Middle Name:THI
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12247 YEARLING PL
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-7658
Mailing Address - Country:US
Mailing Address - Phone:714-229-4898
Mailing Address - Fax:714-229-4899
Practice Address - Street 1:10102 VALLEY VIEW ST
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4344
Practice Address - Country:US
Practice Address - Phone:714-229-4898
Practice Address - Fax:714-229-4899
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA449861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice