Active NPI
Hieu Pham
- Dentist
- Portland, OR
National Provider Identifier
1033593652
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D10274
- Practice address
- 12596 SE Stark St
BLDG N
Portland, OR 97233-1056 - Phone
- (503) 528-4758
- NPI assigned
- Jul 14, 2015
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | D10274 | OR | Primary |
Addresses
Primary practice location
12596 SE Stark St
BLDG N
Portland, OR 97233-1056
Mailing address
4305 NE Glisan St
Portland, OR 97213-1641
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170120001280 | OR | Order and Referring Only - Other (Non-Physician) | 6002198355 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D10274 | OR | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1436832000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1436832000000",
"number": "1033593652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4305 NE GLISAN ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972131641"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12596 SE STARK ST",
"address_2": "BLDG N",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972331056",
"telephone_number": "503-528-4758"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAM",
"first_name": "HIEU",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-07-14",
"last_updated": "2015-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OR",
"license": "D10274",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.