MEDICARE: DR. LIEN NGOC PHAM D.D.S.

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	40483	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	240483	OTHER	CA	DELTA DENTAL-PALMDALE
2	D40483	OTHER	CA	CA FAMILY HEALTH PROGRAM
3	B40483-02	OTHER	CA	DENTICAL-PALMDALE OFF.
4	B40483-01	OTHER	CA	DENTICAL-SAN JOSE OFF.

General Provider Information

NPI Number	:	1255476172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LIEN NGOC PHAM D.D.S.

Provider Business Mailing Address
First Line	:	750 N CAPITOL AVE
Second Line	:	SUITE B1
City	:	SAN JOSE
State	:	CA
Zip	:	95133-1913
Country	:	US
Telephone Number	:	408-254-8800
Fax Number	:	408-929-2678

Provider Business Practice Location Address
First Line	:	750 N CAPITOL AVE
Second Line	:	SUITE B1
City	:	SAN JOSE
State	:	CA
Zip	:	95133-1913
Country	:	US
Telephone Number	:	408-254-8800
Fax Number	:	408-929-2678

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

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. LIEN NGOC PHAM D.D.S.” Practice Location

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