MEDICARE: DR. HIEU D PHAM MD, 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	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	A70740	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972560043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HIEU D PHAM MD, DDS

Provider Business Mailing Address
First Line	:	990 W FREMONT AVE
Second Line	:	SUITE V
City	:	SUNNYVALE
State	:	CA
Zip	:	94087-3021
Country	:	US
Telephone Number	:	408-738-3930
Fax Number	:	408-773-2716

Provider Business Practice Location Address
First Line	:	707 PARNASSUS AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143-2210
Country	:	US
Telephone Number	:	415-476-1313
Fax Number	:	415-476-8999

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

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	01/12/2010

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