Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 105622 | CA |
NPI | 1003415951 |
---|---|
Provider Name | Dr. Tammy Pham |
First Address | Fountain Valley, CA 92708-2440 |
Second Address | North Highlands, CA 95660-5182 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2020 |
Last Update Date | 21/10/2020 |