Active NPI
Thi Binh Phan
- General Practice Dentistry
- San Diego, CA
National Provider Identifier
1114050200
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 40484
- Practice address
- 1540 Fern St
San Diego, CA 92102-1521 - Phone
- (619) 236-9549
- Fax
- (619) 234-0311
- NPI assigned
- Mar 14, 2007
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 40484 | CA | Primary |
Addresses
Primary practice location
1540 Fern St
San Diego, CA 92102-1521
Mailing address
37 Sanctuary Street
Irvine, CA 92620
Phone (714) 309-2383
Other names 1
- Timothy B Phan
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thi Phan Dental Corp | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1114050200",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "37 SANCTUARY STREET",
"city": "IRVINE",
"state": "CA",
"postal_code": "92620",
"telephone_number": "714-309-2383",
"fax_number": "949-262-0204"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1540 FERN ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921021521",
"telephone_number": "619-236-9549",
"fax_number": "619-234-0311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "THI",
"middle_name": "BINH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "40484",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "TIMOTHY",
"last_name": "PHAN",
"middle_name": "B",
"credential": "DDS",
"code": "5",
"type": "Other Name"
}
]
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.