Active NPI
Tan Ba Pham, DMD
- Dentist
- Vancouver, WA
National Provider Identifier
1154479509
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DE00007715
- Practice address
- 9609 E Mill Plan Blvd
Vancouver, WA 98664-3478 - Phone
- (360) 896-3022
- Fax
- (360) 896-4185
- NPI assigned
- Jan 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DE00007715 | WA | Primary |
| Dentist | 122300000X | D7224 | OR |
Addresses
Primary practice location
9609 E Mill Plan Blvd
Vancouver, WA 98664-3478
Mailing address
6950 NE Campus Way
Hillsboro, OR 97124
Phone (503) 952-2164
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 |
|---|---|---|---|
| D7224 | OR | MD | Dentist |
| DE00007715 | WA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1154479509",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6950 NE CAMPUS WAY",
"city": "HILLSBORO",
"state": "OR",
"postal_code": "97124",
"telephone_number": "503-952-2164",
"fax_number": "503-526-4418"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9609 E MILL PLAN BLVD",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986643478",
"telephone_number": "360-896-3022",
"fax_number": "360-896-4185"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAM",
"first_name": "TAN",
"middle_name": "BA",
"name_prefix": "Mr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "DE00007715",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OR",
"license": "D7224",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
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.