Active NPI
Peter Pham, D.D.S.
- General Practice Dentistry
- Downey, CA
National Provider Identifier
1003102336
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 61817
- Practice address
- 12156 Lakewood Blvd
Downey, CA 90242-2658 - Phone
- (562) 803-1600
- NPI assigned
- Jun 24, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 61817 | CA | Primary |
Addresses
Primary practice location
12156 Lakewood Blvd
Downey, CA 90242-2658
Mailing address
18890 Capense St
Fountain Valley, CA 92708-7261
Phone (949) 295-4361
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61817 | CA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| J. Whitley Dental Corporation | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Downey, CA
- NPI 1013218106
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308873600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1433116800000",
"number": "1003102336",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18890 CAPENSE ST",
"city": "FOUNTAIN VALLEY",
"state": "CA",
"postal_code": "927087261",
"telephone_number": "949-295-4361"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12156 LAKEWOOD BLVD",
"city": "DOWNEY",
"state": "CA",
"postal_code": "902422658",
"telephone_number": "562-803-1600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAM",
"first_name": "PETER",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-06-24",
"last_updated": "2015-06-01",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "61817",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Downey, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.