Healthcare Provider Details

I. General information

NPI: 1255341384
Provider Name (Legal Business Name): TAYLOR T. PHAM DDS A PROFESSIONAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7881 VALLEY VIEW ST
LA PALMA CA
90623
US

IV. Provider business mailing address

7881 VALLEY VIEW ST
LA PALMA CA
90623
US

V. Phone/Fax

Practice location:
  • Phone: 714-739-2727
  • Fax: 714-739-2757
Mailing address:
  • Phone: 714-739-2727
  • Fax: 714-739-2757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number43483
License Number StateCA

VIII. Authorized Official

Name: TAYLOR THANH PHAM
Title or Position: OWNER
Credential:
Phone: 714-739-2727