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General NPI Number Information
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NPI Number | 1346083326
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Entity Type | Individual
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Provider Name | KHUE PHAM
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Gender | Female
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Dates
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Enumeration Date | 06/17/2024
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 1630 PLEASANT HILL RD
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City | DULUTH
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State | GA
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Zip | 30096-5899
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Country | US
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Telephone | 770-381-7878
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Fax |
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Provider Business Mailing Address
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Address Line | 5800 CARLTON WAY
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-2700
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Country | US
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Telephone | 404-723-1951
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN123526
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License Number State | GA
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