Provider Demographics
NPI:1609987452
Name:PHAM, HANAH HANH (DDS)
Entity type:Individual
Prefix:DR
First Name:HANAH
Middle Name:HANH
Last Name:PHAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:HANH
Other - Middle Name:HONG
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12359 SUNRISE VALLEY DR
Mailing Address - Street 2:STE 330
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-3462
Mailing Address - Country:US
Mailing Address - Phone:703-860-4148
Mailing Address - Fax:703-991-8761
Practice Address - Street 1:12359 SUNRISE VALLEY DR
Practice Address - Street 2:STE 330
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-3462
Practice Address - Country:US
Practice Address - Phone:703-860-4148
Practice Address - Fax:703-991-8761
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014104111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice