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General NPI Number Information
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NPI Number | 1568015063
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Entity Type | Individual
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Provider Name | JIMMY D PHO DDS
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Gender | Male
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Dates
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Enumeration Date | 07/23/2019
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 9727 SPRING GREEN BLVD STE 200
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City | KATY
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State | TX
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Zip | 77494-4141
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Country | US
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Telephone | 281-697-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 16010 SANDY RING CT
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City | CYPRESS
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State | TX
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Zip | 77429-3899
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Country | US
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Telephone | 832-856-0626
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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 | 35537
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License Number State | TX
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