MEDICARE: GIAI V 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	1223G0001X	General Practice Dentistry	50089	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G9319901	OTHER	CA	DENTI-CAL BILLING NUMBER

General Provider Information

NPI Number	:	1639201221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIAI V PHAM, DMD, INC.

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	:	PRESIDENT
Name	:	DR. GIAI V PHAM
Credential	:	DMD
Telephone Number	:	559-324-9494

Provider Enumeration Date	:	03/10/2007
Last Update Date	:	08/22/2020

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