Provider Demographics
NPI:1124755400
Name:PHAM, JAMES JASON (DMD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:JASON
Last Name:PHAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 THE PROMENADE N UNIT 403
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4738
Mailing Address - Country:US
Mailing Address - Phone:619-793-6501
Mailing Address - Fax:
Practice Address - Street 1:133 THE PROMENADE N UNIT 403
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4738
Practice Address - Country:US
Practice Address - Phone:619-793-6501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107559122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist