Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 63830 | CA |
N | 213EG0000X | General Practice | 63830 | CA |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 63830 | CA |
NPI | 1033510771 |
---|---|
Provider Name | Dr. Jefferey Pham |
First Address | Huntington Beach, CA 92647-4700 |
Second Address | Huntington Beach, CA 92647-4700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2014 |
Last Update Date | 30/07/2019 |