Provider Demographics
NPI:1679760029
Name:NGHIA DINH PHAM &TRANG TO, DMDS, INC.
Entity type:Organization
Organization Name:NGHIA DINH PHAM &TRANG TO, DMDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TRANG
Authorized Official - Middle Name:
Authorized Official - Last Name:TO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-889-1263
Mailing Address - Street 1:14115 GOLDEN WEST ST#A
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-3790
Mailing Address - Country:US
Mailing Address - Phone:714-889-1263
Mailing Address - Fax:714-889-1486
Practice Address - Street 1:14115 GOLDEN WEST ST#A
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-3790
Practice Address - Country:US
Practice Address - Phone:714-889-1263
Practice Address - Fax:714-889-1486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA521211223G0001X
CA521011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1679760029Medicaid
CA1679760029Medicare UPIN
CA1679760029Medicaid
CA1679760029Medicare Oscar/Certification
CA1679760029Medicare NSC