Provider Demographics
NPI:1811160880
Name:PHAM, RICHARD KHOA (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:KHOA
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 1:3820 CONVOY ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3722
Mailing Address - Country:US
Mailing Address - Phone:858-569-1100
Mailing Address - Fax:858-569-2010
Practice Address - Street 1:700 N ZARAGOZA RD STE T
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79907-4735
Practice Address - Country:US
Practice Address - Phone:915-493-2699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX273461223G0001X
CA576801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice