Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | A85351 | CA |
NPI | 1205856598 |
---|---|
Provider Name | Dr. Dieu Quang Pham |
First Address | Fountain Valley, CA 92708-4092 |
Second Address | Fountain Valley, CA 92708-4092 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 03/12/2021 |