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General NPI Number Information
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NPI Number | 1629672357
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Entity Type | Organization
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Legal Business Name | LAN PHAM DDS PHD INC
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Dates
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Enumeration Date | 11/23/2020
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Last Update Date | 11/23/2020
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Provider Practice Location Address
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Address Line | 25209 NARBONNE AVE
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City | LOMITA
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State | CA
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Zip | 90717-2121
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Country | US
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Telephone | 310-539-4166
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Fax |
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Provider Business Mailing Address
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Address Line | 25209 NARBONNE AVE
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City | LOMITA
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State | CA
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Zip | 90717-2121
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Country | US
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Telephone | 651-235-0018
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAN PHAM
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Credential | DDS, PHD
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Telephone | 651-235-0018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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