MEDICARE: GIAI V PHAM DMD

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	1223G0001X	General Practice Dentistry	50089	CA

General Provider Information

NPI Number	:	1497723670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GIAI V PHAM DMD

Provider Business Mailing Address
First Line	:	7090 N CEDAR AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-3300
Country	:	US
Telephone Number	:	559-324-9494
Fax Number	:	559-324-9472

Provider Business Practice Location Address
First Line	:	7090 N CEDAR AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-3300
Country	:	US
Telephone Number	:	559-324-9494
Fax Number	:	559-324-9472

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	01/29/2013

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