Healthcare Provider Details

I. General information

NPI: 1629462387
Provider Name (Legal Business Name): HIEN N PHAM, DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 03/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3151 WILLOW AVE
CLOVIS CA
93612-4717
US

IV. Provider business mailing address

3151 WILLOW AVE
CLOVIS CA
93612-4717
US

V. Phone/Fax

Practice location:
  • Phone: 559-299-9556
  • Fax:
Mailing address:
  • Phone: 559-299-9556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number42396
License Number StateCA

VIII. Authorized Official

Name: DR. HIEN N PHAM
Title or Position: PRESIDENT
Credential: DDS
Phone: 559-299-9556