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Provider Information for 1245643154

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

MAI PHAM DMD

Gender: FEMALE

Individual NPI: 1245643154

Calendar   Last Updated:  2021-09-23
  Certification Date:  2021-09-23

Details

Name Value
NPI 1245643154
Enumeration Date 2014-06-09
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 2414 S FAIRVIEW ST SUITE #101
SANTA ANA, CA 92704-5318
United States

Phone: 714-617-4294 | Fax: 714-242-4070
View Map External Link
Primary Practice Address 2414 S FAIRVIEW ST SUITE #101
SANTA ANA, CA 92704-5318
United States

Phone: 281-298-2433 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 193400000X SINGLE SPECIALTY GROUP
1223G0001X - Dentist General Practice
CA 64449
No 122300000X - Dentist TX 29878