Provider Demographics
NPI:1962545673
Name:PHAM, REGINA TRANG (DDS)
Entity type:Individual
Prefix:DR
First Name:REGINA
Middle Name:TRANG
Last Name:PHAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3482 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-2809
Mailing Address - Country:US
Mailing Address - Phone:408-249-4444
Mailing Address - Fax:408-249-4488
Practice Address - Street 1:3482 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-2809
Practice Address - Country:US
Practice Address - Phone:408-249-4444
Practice Address - Fax:408-249-4488
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37594122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3759401Medicaid