Basic Information
| Provider Information | |||||||||
| NPI: | 1487886594 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PHAM | ||||||||
| FirstName: | TRINH | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1251 S BERKLEY ST | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928044607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7143100913 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2156 E LINCOLN AVE | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928064104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7143993140 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2009 | ||||||||
| LastUpdateDate: | 11/16/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0221X | 50054621 | NY | N | Dental Providers | Dentist | Pediatric Dentistry | 1223P0221X | 59266 | CA | Y | Dental Providers | Dentist | Pediatric Dentistry |
No ID Information.