Healthcare Provider Details

I. General information

NPI: 1477785103
Provider Name (Legal Business Name): SHARON PHAMDUONG D.D.S., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2009
Last Update Date: 04/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 TORRANCE BLVD STE 450
TORRANCE CA
90503-4592
US

IV. Provider business mailing address

4201 TORRANCE BLVD STE 450
TORRANCE CA
90503-4592
US

V. Phone/Fax

Practice location:
  • Phone: 310-540-1415
  • Fax:
Mailing address:
  • Phone: 310-540-1415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number53098
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: