Provider Demographics
NPI:1972560043
Name:PHAM, HIEU D (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:HIEU
Middle Name:D
Last Name:PHAM
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 W FREMONT AVE
Mailing Address - Street 2:SUITE V
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-3021
Mailing Address - Country:US
Mailing Address - Phone:408-738-3930
Mailing Address - Fax:408-773-2716
Practice Address - Street 1:707 PARNASSUS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2210
Practice Address - Country:US
Practice Address - Phone:415-476-1313
Practice Address - Fax:415-476-8999
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70740204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A707400Medicaid
CAH41876Medicare UPIN
CA00A707400Medicaid