Healthcare Provider Details

I. General information

NPI: 1669235172
Provider Name (Legal Business Name): ANH THE NHAT PHAM DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 WETZEL STE A
KYLE TX
78640-2131
US

IV. Provider business mailing address

8410 DATAPOINT DR
SAN ANTONIO TX
78229-3220
US

V. Phone/Fax

Practice location:
  • Phone: 512-256-0206
  • Fax:
Mailing address:
  • Phone: 714-548-9554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number41287
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: