Basic Information
| Provider Information | |||||||||
| NPI: | 1922193754 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHAM | ||||||||
| FirstName: | MINH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2860 MICHELLE DRIVE | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145083600 | ||||||||
| FaxNumber: | 7143682092 | ||||||||
| Practice Location | |||||||||
| Address1: | 9503 NE 2ND AVE | ||||||||
| Address2: | |||||||||
| City: | MIAMI SHORES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331382704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7863104816 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 04/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 21177 | FL | N | Dental Providers | Dentist | General Practice | 1223G0001X | 46321 | CA | N | Dental Providers | Dentist | General Practice | 122300000X | 21177 | FL | Y | Dental Providers | Dentist |
No ID Information.