Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0221X | Pediatric Dentist | 019.031604 | IL |
Y | 1223P0221X | Pediatric Dentist | DEN1002122 | DC |
NPI | 1003264821 |
---|---|
Provider Name | Dr. Chi-Lan Pham |
First Address | Washington, DC 20016-2175 |
Second Address | Washington, DC 20016-2175 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2016 |
Last Update Date | 09/09/2021 |