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General NPI Number Information
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NPI Number | 1194022111
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Entity Type | Individual
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Provider Name | PETER H PHAM DDS
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Gender | Male
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Dates
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Enumeration Date | 02/28/2011
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Last Update Date | 10/02/2020
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Provider Practice Location Address
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Address Line | 18220 YORBA LINDA BLVD STE 305
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City | YORBA LINDA
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State | CA
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Zip | 92886-4032
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Country | US
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Telephone | 714-528-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 414 TANGERINE PL
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City | BREA
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State | CA
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Zip | 92823-1809
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Country | US
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Telephone | 714-904-8635
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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 | 50812
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License Number State | CA
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