Provider Demographics
NPI:1851498968
Name:PHAM, HUNG DUY (DDS)
Entity type:Individual
Prefix:DR
First Name:HUNG
Middle Name:DUY
Last Name:PHAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:1001 SAN BRUNO AVE W
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-3318
Mailing Address - Country:US
Mailing Address - Phone:650-989-9299
Mailing Address - Fax:650-989-9257
Practice Address - Street 1:1001 SAN BRUNO AVE W
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-3318
Practice Address - Country:US
Practice Address - Phone:650-989-9299
Practice Address - Fax:650-989-9257
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA465141223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry