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General NPI Number Information
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NPI Number | 1003102336
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Entity Type | Individual
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Provider Name | PETER PHAM D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/24/2011
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Last Update Date | 06/01/2015
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Provider Practice Location Address
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Address Line | 12156 LAKEWOOD BLVD
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City | DOWNEY
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State | CA
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Zip | 90242-2658
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Country | US
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Telephone | 562-803-1600
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Fax |
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Provider Business Mailing Address
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Address Line | 18890 CAPENSE ST
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-7261
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Country | US
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Telephone | 949-295-4361
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 61817
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License Number State | CA
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