Healthcare Provider Details

I. General information

NPI: 1275151805
Provider Name (Legal Business Name): ALISA PHAM DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 5TH ST
SAN FRANCISCO CA
94103-2919
US

IV. Provider business mailing address

120 KENTON DR
SANTA ANA CA
92704-1400
US

V. Phone/Fax

Practice location:
  • Phone: 714-360-4470
  • Fax:
Mailing address:
  • Phone: 714-360-4470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDDS106012
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: