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General NPI Number Information
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NPI Number | 1619122751
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Entity Type | Individual
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Provider Name | CHANDRA THANH-CHUONG PHAM D.D.S
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Gender | Female
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Dates
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Enumeration Date | 11/17/2008
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Last Update Date | 11/12/2014
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Provider Practice Location Address
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Address Line | 3270 LANDESS AVE
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City | SAN JOSE
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State | CA
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Zip | 95132-1230
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Country | US
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Telephone | 408-565-5296
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Fax |
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Provider Business Mailing Address
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Address Line | 315 FAIRHAVEN BLVD
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City | WOODBURY
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State | NY
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Zip | 11797-1629
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Country | US
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Telephone | 408-565-5296
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 054700
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 63201
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License Number State | CA
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