MEDICARE: KAREN PHAM, DMD, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	B44244-01	CA

General Provider Information

NPI Number	:	1427237353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAREN PHAM, DMD, INC.

Provider Business Mailing Address
First Line	:	4074 MONTEREY RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95111-3633
Country	:	US
Telephone Number	:	408-972-9990
Fax Number	:	408-972-8666

Provider Business Practice Location Address
First Line	:	4074 MONTEREY RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95111-3633
Country	:	US
Telephone Number	:	408-972-9990
Fax Number	:	408-972-8666

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. KAREN PHAM
Credential	:	D.M.D
Telephone Number	:	408-972-9990

Provider Enumeration Date	:	10/28/2007
Last Update Date	:	10/28/2007

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