Derrick Anh Vo Pham, DENTAL STUDENT

Primary specialty

DentistTaxonomy code 122300000X

License

106380 Issued in CA

Practice address

92055 14TH Street
Oceanside, CA 92058

Phone

(760) 725-5870

NPI assigned

May 29, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1590710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630281600000",
    "number": "1023632676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4270 KIRKCALDY DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921113621",
            "telephone_number": "858-999-1299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "92055 14TH STREET",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "92058",
            "telephone_number": "760-725-5870"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "714 Tiverton Ave",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900958361",
            "country_code": "US",
            "telephone_number": "310-825-9789",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "Navy Medicine Support Command Attn: Medical Staff Svcs",
            "address_2": "Bldg H 2005 Knight Lane",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322120140",
            "country_code": "US",
            "telephone_number": "760-725-3213",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHAM",
        "first_name": "DERRICK",
        "middle_name": "ANH VO",
        "credential": "DENTAL STUDENT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-05-29",
        "last_updated": "2021-08-30",
        "certification_date": "2021-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "106380",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joel Nicholas Peterson, M.D.
• Leslie Peterson, MSW
• Shelby Peterson, PT, DPT
• Richard K. Petyn, M.D.
• Elmera Peyman, DO
• Linh T Phan, DDS
• Angela Phanthao
• Jacilyn Summer Pharris, OTR/L
• Hannah Phelps
• Sarai McCall Phelps

• Dentist in Oceanside, CA
• Providers in Oceanside, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.