Individual provider Active NPI

Tiffany Phan Nguyen, DDS

  • General Practice Dentistry
  • Sacramento, CA
National Provider Identifier
1023737285
Registry record updated Aug 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
107791 Issued in CA
Practice address
4690 Natomas Blvd
Ste 100
Sacramento, CA 95835
Phone
(916) 515-4500
NPI assigned
Aug 23, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 107791 CA Primary

Addresses

Primary practice location

4690 Natomas Blvd
Ste 100
Sacramento, CA 95835

Mailing address

4690 Natomas Blvd Ste 100
Sacramento, CA 95835-2230
Phone (916) 515-4500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221108003138 CA Order and Referring Only - DentistPractitioner - Dentist 7214304039

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
107791CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Hoang and Rho Dental Corporation General Practice PastSince Aug 28, 2022 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.

NPI Registry JSON

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

{
    "created_epoch": "1661212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661212800000",
    "number": "1023737285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4690 NATOMAS BLVD STE 100",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958352230",
            "telephone_number": "916-515-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4690 NATOMAS BLVD",
            "address_2": "STE 100",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "95835",
            "telephone_number": "916-515-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "TIFFANY",
        "middle_name": "PHAN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-23",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "107791",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.