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General NPI Number Information
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NPI Number | 1558343715
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Entity Type | Individual
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Provider Name | KHANHLAM KIM PHAN D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 11/15/2005
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 137 N MONTEBELLO BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640-4797
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Country | US
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Telephone | 425-505-7263
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Fax | 425-505-7263
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Provider Business Mailing Address
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Address Line | 504 16TH ST
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-4014
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Country | US
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Telephone | 425-505-7263
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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 | 56940
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License Number State | CA
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