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General NPI Number Information
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NPI Number | 1821159096
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Entity Type | Individual
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Provider Name | GEM T PHAM DDS
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Gender | Male
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 15708 POMERADO RD SUITE N 103
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City | POWAY
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State | CA
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Zip | 92064-2066
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Country | US
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Telephone | 858-385-9295
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Fax | 858-385-9298
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Provider Business Mailing Address
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Address Line | 14539 ARROYO HONDO
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City | SAN DIEGO
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State | CA
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Zip | 92127-3640
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Country | US
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Telephone | 858-385-9295
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Fax | 858-385-9298
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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 | 44760
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License Number State | CA
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