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General NPI Number Information
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NPI Number | 1245828219
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Entity Type | Organization
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Legal Business Name | DERICK PHAM DMD, INC
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Dates
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Enumeration Date | 01/06/2021
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Last Update Date | 01/06/2021
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Provider Practice Location Address
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Address Line | 3612 FLORISTA ST
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-2423
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Country | US
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Telephone | 562-598-4207
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Fax |
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Provider Business Mailing Address
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Address Line | 3612 FLORISTA ST
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-2423
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Country | US
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Telephone | 562-598-4207
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. DERICK PHAM
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Credential | DMD
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Telephone | 631-693-9040
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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 |
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License Number State |
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