Provider Demographics
NPI:1972645638
Name:PHAM, CHIEU L (DDS)
Entity Type:Individual
Prefix:
First Name:CHIEU
Middle Name:L
Last Name:PHAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:L
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:12395 EL CAMINO REAL #218
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130
Mailing Address - Country:US
Mailing Address - Phone:408-390-7228
Mailing Address - Fax:
Practice Address - Street 1:12395 EL CAMINO REAL STE 218
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-3084
Practice Address - Country:US
Practice Address - Phone:408-390-7228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA529161223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry