Active NPI
Anhtuan Van Phan, LD
- Denturist
- Tacoma, WA
National Provider Identifier
1154113538
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Denturist
- License
- 61521236
- Practice address
- 7808 Pacific Ave Ste 6
Tacoma, WA 98408-7039 - Phone
- (253) 617-5704
- NPI assigned
- May 21, 2025
- 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 |
|---|---|---|---|---|
| Denturist | 122400000X | 61521236 | WA | Primary |
Addresses
Primary practice location
7808 Pacific Ave Ste 6
Tacoma, WA 98408-7039
Mailing address
9518 McKinley Ave
Tacoma, WA 98445-2168
Phone (253) 617-5704
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 |
|---|---|---|---|
| 61521236 | WA | MD | Denturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1747785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1747785600000",
"number": "1154113538",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9518 MCKINLEY AVE",
"city": "TACOMA",
"state": "WA",
"postal_code": "984452168",
"telephone_number": "253-617-5704"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7808 PACIFIC AVE STE 6",
"city": "TACOMA",
"state": "WA",
"postal_code": "984087039",
"telephone_number": "253-617-5704"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "ANHTUAN",
"middle_name": "VAN",
"credential": "LD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-05-21",
"last_updated": "2025-05-21",
"certification_date": "2025-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "122400000X",
"taxonomy_group": "",
"desc": "Denturist",
"state": "WA",
"license": "61521236",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.