Individual
DERRICK ANH VO PHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DENTAL STUDENT
Contact information
Practice address
92055 14TH STREET, OCEANSIDE, CA 92058
(760) 725-5870
Mailing address
4270 KIRKCALDY DR, SAN DIEGO, CA 92111-3621
(858) 999-1299
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
106380
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
CA
Other
Enumeration date
05/29/2020
Last updated
08/30/2021
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