Anthony Minhduc Huy Phan, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

102834 Issued in CA

Practice address

5060 Sunrise Blvd Ste A1
Fair Oaks, CA 95628-4944

Phone

(916) 622-5681

NPI assigned

Jul 22, 2016

Last updated

May 11, 2020By the provider in NPPES

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1469145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589155200000",
    "number": "1225481567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5041 CHICO DR",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "957474277",
            "telephone_number": "916-622-5681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5060 SUNRISE BLVD STE A1",
            "city": "FAIR OAKS",
            "state": "CA",
            "postal_code": "956284944",
            "telephone_number": "916-622-5681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "ANTHONY MINHDUC",
        "middle_name": "HUY",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-07-22",
        "last_updated": "2020-05-11",
        "certification_date": "2020-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "102834",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bobbi Peters
• Laurie J Peters, M.D.
• Krystal Pettit, LVN
• Maivi Pham, PHARMD
• Sarah Lynn Pham
• Juleigh Pierce
• Jana Pinkley
• Alyssa Nicole Piombo, RDN
• Cheryl Marie Pitts
• Joan Madeleine Plastino, L.AC.

• General Practice Dentistry in Fair Oaks, CA
• Providers in Fair Oaks, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2020; 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.