Individual
KELLY PHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
1211 MERIDIAN AVE, SAN JOSE, CA 95125-5210
(408) 445-3400
Mailing address
1211 MERIDIAN AVE, SAN JOSE, CA 95125-5210
(408) 445-3400
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
24883
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
124Q00000X
DENTAL HYGIENIST
CA
Enumeration date
12/06/2016
Last updated
12/06/2016
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