MEDICARE: HY TIEP 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	1223G0001X	General Practice Dentistry	30286	CA

General Provider Information

NPI Number	:	1255342473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HY TIEP PHAM DDS

Provider Business Mailing Address
First Line	:	1406 ATLANTIC AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813
Country	:	US
Telephone Number	:	562-599-6677
Fax Number	:	562-599-0403

Provider Business Practice Location Address
First Line	:	1406 ATLANTIC AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813
Country	:	US
Telephone Number	:	562-599-6677
Fax Number	:	562-599-0403

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	07/08/2007

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