Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | HAP653 | CA |
NPI | 1033647532 |
---|---|
Provider Name | Myloan Pham |
First Address | Rocklin, CA 95765-5820 |
Second Address | Rocklin, CA 95765-5820 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2017 |
Last Update Date | 26/05/2017 |