Individual
DERICK PHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6840 EASTERN AVE STE A, BELL GARDENS, CA 90201-3902
(323) 513-0842
Mailing address
1023 MAPLE AVE, HARTFORD, CT 06114-2733
(714) 457-0064
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
103577
CA
Other
Enumeration date
03/30/2017
Last updated
05/21/2019
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