Jeffrey Phen, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

44988 Issued in CA

Practice address

850 W March LN
Suite B
Stockton, CA 95207-6207

Phone

(209) 474-0888

Fax

(209) 474-3342

NPI assigned

May 17, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Jeffrey Phen DDS a Dental Corporation

  dba Venetian Square Family Dental

  • General Practice Dentistry
  • Stockton, CA
  • NPI 1740466572
  NPD (past) Authorized official

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278547200000",
    "number": "1043262744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 W MARCH LN",
            "address_2": "SUITE B",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952076207",
            "telephone_number": "209-474-0888",
            "fax_number": "209-474-3342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 W MARCH LN",
            "address_2": "SUITE B",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952076207",
            "telephone_number": "209-474-0888",
            "fax_number": "209-474-3342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHEN",
        "first_name": "JEFFREY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2010-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "44988",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "000604467",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G91849",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jasmine Arrielynn Pharms
• Asuka Morooka Pheap, MA, ATC
• Tamara L Phelan, P. T.
• Selest Phelk
• Jacob Xavier Phen
• Britney Starla Phetbourom
• Alyssa Myra Phillips
• Heather Elizabeth Phillips, LPT
• Ruby Sara Phillips, PH.D.
• Russell S Phillips

• General Practice Dentistry in Stockton, CA
• Providers in Stockton, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2010; 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.

Verify at the official NPI Registry.