MEDICARE: TRINH T PHAM D.D.S.

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	1223P0221X	Pediatric Dentistry	50054621	NY
2	1223P0221X	Pediatric Dentistry	59266	CA

General Provider Information

NPI Number	:	1487886594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRINH T PHAM D.D.S.

Provider Business Mailing Address
First Line	:	1251 S BERKLEY ST
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92804-4607
Country	:	US
Telephone Number	:	714-310-0913
Fax Number	:

Provider Business Practice Location Address
First Line	:	2156 E LINCOLN AVE
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92806-4104
Country	:	US
Telephone Number	:	714-399-3140
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2009
Last Update Date	:	11/16/2010

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Directions to “ TRINH T PHAM D.D.S.” Practice Location

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