MEDICARE: DR. LANCHI NGOC 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	57639	CA

General Provider Information

NPI Number	:	1952558454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LANCHI NGOC PHAM DMD

Provider Business Mailing Address
First Line	:	PO BOX 4919
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92842-4919
Country	:	US
Telephone Number	:	714-539-8899
Fax Number	:	714-534-3053

Provider Business Practice Location Address
First Line	:	12732 BROOKHURST ST
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92840-4810
Country	:	US
Telephone Number	:	714-539-8899
Fax Number	:	714-534-3053

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

Provider Enumeration Date	:	08/26/2008
Last Update Date	:	08/26/2008

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