Active NPI
Kathleen P Phan, DMD
- Dentist
- Los Gatos, CA
National Provider Identifier
1043044613
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 110051
- Practice address
- 14501 S Bascom Ave Ste G
Los Gatos, CA 95032-2003 - Phone
- (408) 214-6752
- NPI assigned
- Aug 27, 2024
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 110051 | CA | Primary |
Addresses
Primary practice location
14501 S Bascom Ave Ste G
Los Gatos, CA 95032-2003
Mailing address
634 True Wind Way Unit 803
Redwood City, CA 94063-5733
Phone (408) 250-1375
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 |
|---|---|---|---|
| 110051 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1724716800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724716800000",
"number": "1043044613",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "634 TRUE WIND WAY UNIT 803",
"city": "REDWOOD CITY",
"state": "CA",
"postal_code": "940635733",
"telephone_number": "408-250-1375"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14501 S BASCOM AVE STE G",
"city": "LOS GATOS",
"state": "CA",
"postal_code": "950322003",
"telephone_number": "408-214-6752"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "KATHLEEN",
"middle_name": "P",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-08-27",
"last_updated": "2024-08-27",
"certification_date": "2024-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "110051",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Gatos, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.