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General NPI Number Information
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NPI Number | 1801027016
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Entity Type | Individual
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Provider Name | THAO KIM PHAM DDS
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Gender | Female
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Dates
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Enumeration Date | 08/05/2009
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Last Update Date | 07/23/2015
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Provider Practice Location Address
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Address Line | 2950 N FRESNO ST
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City | FRESNO
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State | CA
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Zip | 93703-1123
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Country | US
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Telephone | 559-355-3914
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Fax |
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Provider Business Mailing Address
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Address Line | 161 HOUSTON AVE
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City | CLOVIS
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State | CA
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Zip | 93611-7089
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Country | US
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Telephone | 559-355-3914
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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 | 58612
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 58612
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License Number State | CA
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