MEDICARE: DR. VANTI PHAM DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	45518	CA

General Provider Information

NPI Number	:	1174725105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VANTI PHAM DDS

Provider Business Mailing Address
First Line	:	3151 S HOOVER
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-0001
Country	:	US
Telephone Number	:	213-740-2012
Fax Number	:

Provider Business Practice Location Address
First Line	:	3151 S HOOVER
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-0001
Country	:	US
Telephone Number	:	213-740-2012
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	07/08/2007

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