Quy-Phung Thi Phan, D.D.S

Primary specialty

DentistTaxonomy code 122300000X

License

50090 Issued in CA

Practice address

628 Running Deer Rd
Walnut, CA 91789-4299

Phone

(626) 581-8209

NPI assigned

Feb 22, 2009

Last updated

Feb 22, 2009By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1235260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1235260800000",
    "number": "1164662789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "628 RUNNING DEER RD",
            "city": "WALNUT",
            "state": "CA",
            "postal_code": "917894299",
            "telephone_number": "626-581-8209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "628 RUNNING DEER RD",
            "city": "WALNUT",
            "state": "CA",
            "postal_code": "917894299",
            "telephone_number": "626-581-8209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "QUY-PHUNG",
        "middle_name": "THI",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-02-22",
        "last_updated": "2009-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "50090",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Saijai Peng, DDS., MSD.
• Yen Wen Peng, D.C.
• Mark Cadiente Peralta, D.P.T
• Peter C. Liu D.D.S., Inc. (Walnut Dental Specialists)
• Marie Mar Phan, PHARM. D.
• Jennifer Pierce
• Sandra Alicia Pinon-Chavez, M.S
• Platinum Interpreting, Inc.
• Charmane Ponghirun, D.D.S.
• Precious Home Health Services, Inc

• Dentist in Walnut, CA
• Providers in Walnut, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.