Active NPI
Stacy Mai Pham, DDS
- Dentist
- Riverside, CA
National Provider Identifier
1063420255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 39461
- Practice address
- 4000 Tyler St
Riverside, CA 92503 - Phone
- (951) 687-4155
- Fax
- (951) 687-7448
- NPI assigned
- Aug 3, 2006
- Sex
- Female
- 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 | 39461 | CA | Primary |
Addresses
Primary practice location
4000 Tyler St
Riverside, CA 92503
Mailing address
4000 Tyler St
Riverside, CA 92503
Phone (951) 687-4155
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 |
|---|---|---|---|
| 39461 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580083200000",
"number": "1063420255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4000 TYLER ST",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "92503",
"telephone_number": "951-687-4155",
"fax_number": "951-687-7448"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4000 TYLER ST",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "92503",
"telephone_number": "951-687-4155",
"fax_number": "951-687-7448"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAM",
"first_name": "STACY",
"middle_name": "MAI",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-03",
"last_updated": "2020-01-27",
"certification_date": "2020-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "39461",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.