Provider Demographics
NPI:1013479518
Name:PHAM, PAULINE (DDS)
Entity type:Individual
Prefix:
First Name:PAULINE
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 1:4545 CENTER BLVD APT 2220
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11109-5947
Mailing Address - Country:US
Mailing Address - Phone:408-829-5490
Mailing Address - Fax:
Practice Address - Street 1:244 W 54TH ST STE 614
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-5515
Practice Address - Country:US
Practice Address - Phone:212-757-3183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program