MEDICARE: KAREN PHAM DMD

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	44244	CA

General Provider Information

NPI Number	:	1750403515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN PHAM DMD

Provider Business Mailing Address
First Line	:	4074 MONTEREY ROAD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95111
Country	:	US
Telephone Number	:	408-972-9990
Fax Number	:	408-972-8666

Provider Business Practice Location Address
First Line	:	4074 MONTEREY ROAD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95111
Country	:	US
Telephone Number	:	408-972-9990
Fax Number	:	408-972-8666

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

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	03/23/2018

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