Active NPI
Minh-Tom Van, DDS
- General Practice Dentistry
- New York, NY
National Provider Identifier
1164115713
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 064693
- Practice address
- 423 E 23Rd St
New York, NY 10010-5011 - Phone
- (212) 686-7500
- NPI assigned
- May 31, 2023
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DEN.00205637 | CO | |
| General Practice Dentistry | 1223G0001X | 110503 | CA | |
| General Practice Dentistry | 1223G0001X | 064693 | NY | Primary |
Addresses
Primary practice location
423 E 23Rd St
New York, NY 10010-5011
Mailing address
12420 W Auburn Ave
Lakewood, CO 80228-4986
Phone (720) 998-2963
Other practice location 1
150 S Huntington Ave
Boston, MA 02130-4817
Phone (617) 232-9500
Other practice location 2
4516 Atlantic Ave
Long Beach, CA 90807-1513
Phone (562) 437-0647
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 |
|---|---|---|---|
| 110503 | CA | MD | Clinical Social Worker |
| DEN.00205637 | CO | MD | General Practice Dentistry |
| 064693 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1685491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752105600000",
"number": "1164115713",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12420 W AUBURN AVE",
"city": "LAKEWOOD",
"state": "CO",
"postal_code": "802284986",
"telephone_number": "720-998-2963"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "423 E 23RD ST",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100105011",
"telephone_number": "212-686-7500"
}
],
"practiceLocations": [
{
"address_1": "150 S Huntington Ave",
"address_purpose": "LOCATION",
"city": "Boston",
"state": "MA",
"postal_code": "021304817",
"country_code": "US",
"telephone_number": "617-232-9500",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4516 Atlantic Ave",
"address_purpose": "LOCATION",
"city": "Long Beach",
"state": "CA",
"postal_code": "908071513",
"country_code": "US",
"telephone_number": "562-437-0647",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "VAN",
"first_name": "MINH-TOM",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-05-31",
"last_updated": "2025-07-10",
"certification_date": "2025-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, General Practice",
"state": "CO",
"license": "DEN.00205637",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "110503",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "064693",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 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.