Active NPI
Derick Pham
- Dentist
- Bell Gardens, CA
National Provider Identifier
1093247074
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 103577
- Practice address
- 6840 Eastern Ave Ste a
Bell Gardens, CA 90201-3902 - Phone
- (323) 513-0842
- NPI assigned
- Mar 30, 2017
- Last updated
- May 21, 2019
- 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 | 103577 | CA | Primary |
Addresses
Primary practice location
6840 Eastern Ave Ste a
Bell Gardens, CA 90201-3902
Mailing address
1023 Maple Ave
Hartford, CT 06114-2733
Phone (714) 457-0064
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 |
|---|---|---|---|
| 103577 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pham Vo Dental Partnership | Current | Accepting new patients | |
| Derick Pham DMD, Inc | Current | Accepting new patients |
Locations
1131 Foothill Blvd
La Verne, CA 91750
Phone (909) 596-6551
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Practice Dentistry
- La Verne, CA
- NPI 1215705678
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490832000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1558396800000",
"number": "1093247074",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1023 MAPLE AVE",
"city": "HARTFORD",
"state": "CT",
"postal_code": "061142733",
"telephone_number": "714-457-0064"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6840 EASTERN AVE STE A",
"city": "BELL GARDENS",
"state": "CA",
"postal_code": "902013902",
"telephone_number": "323-513-0842"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAM",
"first_name": "DERICK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-03-30",
"last_updated": "2019-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "103577",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bell Gardens, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.