Active NPI
John Pham, D.P.M.
- Foot Surgery Podiatrist
- Loma Linda, CA
National Provider Identifier
1104929140
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Foot Surgery Podiatrist
- License
- E4417
- Practice address
- 11201 Benton St
Loma Linda, CA 92357-1000 - Phone
- (909) 825-7084
- NPI assigned
- Sep 6, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Foot Surgery Podiatrist | 213ES0131X | E4417 | CA | Primary |
Addresses
Primary practice location
11201 Benton St
Loma Linda, CA 92357-1000
Mailing address
11201 Benton St
Loma Linda, CA 92357-1000
Phone (909) 825-7084
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4417 | CA | MD | Psychiatry Physician |
| E4417 | CA | MD | Foot Surgery Podiatrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1291075200000",
"number": "1104929140",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11201 BENTON ST",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923571000",
"telephone_number": "909-825-7084"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11201 BENTON ST",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923571000",
"telephone_number": "909-825-7084"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAM",
"first_name": "JOHN",
"name_prefix": "Dr.",
"credential": "D.P.M.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-06",
"last_updated": "2010-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "213ES0131X",
"taxonomy_group": "",
"desc": "Podiatrist, Foot Surgery",
"state": "CA",
"license": "E4417",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Loma Linda, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 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.