Provider Demographics
NPI:1831267053
Name:PHAM, FRANK PHONG
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:PHONG
Last Name:PHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 N LEMON ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1205
Mailing Address - Country:US
Mailing Address - Phone:714-290-9394
Mailing Address - Fax:714-525-8238
Practice Address - Street 1:1602 N LEMON ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1205
Practice Address - Country:US
Practice Address - Phone:714-290-9394
Practice Address - Fax:714-525-8238
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA491841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice