John Pham, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

DE00008608 Issued in WA

Practice address

1515 NW Louisiana Ave
Chehalis, WA 98532-1748

Phone

(360) 740-6212

Fax

(360) 740-6222

NPI assigned

Feb 2, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Three Rivers Dental

  dba Rainier Park Dental

  • General Practice Dentistry
  • Rainier, OR
  • NPI 1467536318
  NPD (past) Authorized official

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

{
    "created_epoch": "1233532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1233532800000",
    "number": "1114165966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 NW LOUISIANA AVE",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "985321748",
            "telephone_number": "360-740-6212",
            "fax_number": "360-740-6222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 NW LOUISIANA AVE",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "985321748",
            "telephone_number": "360-740-6212",
            "fax_number": "360-740-6222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAM",
        "first_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-02-02",
        "last_updated": "2009-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE00008608",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D6843",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Personal Hearing Systems, Inc (Raymond Place Enterprises, Inc)
• Peter C. Wagner, D.M.D., P.S.
• Jason R Peterman, R.N.
• Dale Raymond Peters, DC
• Joshua M Petersen, M.ED, LAT, ATC
• Norma Jane Phillips, LMT
• Virginia M Pickett, HS
• Zachary Allen Pilz, A.A.
• Amir M Piranfar, PHARM.D.
• Tracy Plant, RN

• Dentist in Chehalis, WA
• Providers in Chehalis, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.