NPIMap

Individual provider Active NPI

Hiep Duy Pham, DDS

  • General Practice Dentistry
  • Pearland, TX
National Provider Identifier
1144330499
Registry record updated Jun 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
19860 Issued in TX
Practice address
5103 Broadway St Ste 109
Pearland, TX 77581-3959
Phone
(281) 485-7767
Fax
(281) 485-7745
NPI assigned
Aug 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 19860 TX Primary

Addresses

Primary practice location

5103 Broadway St Ste 109
Pearland, TX 77581-3959

Mailing address

5103 Broadway St Ste 109
Pearland, TX 77581-3959
Phone (713) 498-3417

Other practice location 1

4318 West Fuqua
Houston, TX 77045
Phone (713) 433-7500

Other identifiers 1

IdentifierTypeStateIssuer
111233601MedicaidTX

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

LicenseStateTypeSpecialty
19860TXMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Centra One Dental General Practice Past Accepting new patients
Centra One Dental PA General Practice Past Accepting new patients
Centra Two Dental General Practice PastSince Jun 15, 2021 Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623283200000",
    "number": "1144330499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5103 BROADWAY ST STE 109",
            "city": "PEARLAND",
            "state": "TX",
            "postal_code": "775813959",
            "telephone_number": "713-498-3417",
            "fax_number": "281-485-7745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5103 BROADWAY ST STE 109",
            "city": "PEARLAND",
            "state": "TX",
            "postal_code": "775813959",
            "telephone_number": "281-485-7767",
            "fax_number": "281-485-7745"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4318 West Fuqua",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "77045",
            "country_code": "US",
            "telephone_number": "713-433-7500",
            "fax_number": "713-433-6245",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHAM",
        "first_name": "HIEP",
        "middle_name": "DUY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2021-06-10",
        "certification_date": "2021-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "19860",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111233601",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pearland, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2021; 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.