Healthcare Provider Details

I. General information

NPI: 1124201496
Provider Name (Legal Business Name): LIEN NGOC PHAM DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2541 E AVENUE S SUITE B
PALMDALE CA
93550-6402
US

IV. Provider business mailing address

2541 E AVENUE S SUITE B
PALMDALE CA
93550-6402
US

V. Phone/Fax

Practice location:
  • Phone: 661-274-8800
  • Fax:
Mailing address:
  • Phone: 661-274-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. LIEN NGOC PHAM
Title or Position: DENTIST
Credential: DDS
Phone: 408-254-8800