Healthcare Provider Details

I. General information

NPI: 1922193754
Provider Name (Legal Business Name): MINH PHAM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9503 NE 2ND AVE
MIAMI SHORES FL
33138-2704
US

IV. Provider business mailing address

2860 MICHELLE DRIVE 2ND FLOOR
IRVINE CA
92606
US

V. Phone/Fax

Practice location:
  • Phone: 786-310-4816
  • Fax:
Mailing address:
  • Phone: 714-508-3600
  • Fax: 714-368-2092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN10000083
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number46321
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number18373
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN014719
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number21177
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0401418820
License Number StateVA
# 7
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number30.027864
License Number StateOH
# 8
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number12430
License Number StateTN
# 9
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number21177
License Number StateFL
# 10
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number10350
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: