Provider Demographics
NPI:1124277736
Name:PHAM, KRYSTAL HONG-QUYEN (DDS)
Entity type:Individual
Prefix:DR
First Name:KRYSTAL
Middle Name:HONG-QUYEN
Last Name:PHAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KRYSTAL
Other - Middle Name:HONG-QUYEN
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:16052 BEACH BLVD
Mailing Address - Street 2:STE 112
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3801
Mailing Address - Country:US
Mailing Address - Phone:714-841-0203
Mailing Address - Fax:
Practice Address - Street 1:16052 BEACH BLVD STE 112
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3842
Practice Address - Country:US
Practice Address - Phone:714-841-0203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA574731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice