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General NPI Number Information
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NPI Number | 1275151805
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Entity Type | Individual
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Provider Name | ALISA PHAM DDS
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Gender | Female
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Dates
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Enumeration Date | 07/09/2020
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 155 5TH ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94103-2919
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Country | US
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Telephone | 714-360-4470
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Fax |
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Provider Business Mailing Address
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Address Line | 120 KENTON DR
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City | SANTA ANA
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State | CA
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Zip | 92704-1400
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Country | US
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Telephone | 714-360-4470
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DDS106012
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License Number State | CA
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