Healthcare Provider Details

I. General information

NPI: 1346083326
Provider Name (Legal Business Name): KHUE PHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3979 BUFORD HWY NE STE 122
ATLANTA GA
30345-1683
US

IV. Provider business mailing address

2541 KENSWICK CIR
LAWRENCEVILLE GA
30044-5209
US

V. Phone/Fax

Practice location:
  • Phone: 470-702-9000
  • Fax:
Mailing address:
  • Phone: 404-723-1951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN123526
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: