Individual provider Active NPI

Tiffany Pham, OD

  • Optometrist
  • Chino Hills, CA
National Provider Identifier
1225790322
Registry record updated Oct 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
35028 Issued in CA
Practice address
4200 Chino Hills Pkwy Ste 390
Chino Hills, CA 91709-5825
Phone
(909) 393-9058
Fax
(909) 393-7298
NPI assigned
Oct 6, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 35028 CA Primary

Addresses

Primary practice location

4200 Chino Hills Pkwy Ste 390
Chino Hills, CA 91709-5825

Mailing address

2879 N Weston St
Orange, CA 92867-2286
Phone (714) 595-4623

Other practice location 1

428 S Brea Blvd
Brea, CA 92821-5301
Phone (714) 529-2470

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20211018002154 CA Practitioner - Optometry 4587062856 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of California - School of Optometry, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1700 Hamner Ave
Suite 102
Norco, CA 92860-2957
Phone (951) 735-7122

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Corona Valley Optometry Inc Optometrist CurrentSince Mar 23, 2024 Accepting new patients
Norco Valley Optometry, Inc Optometrist CurrentSince Jan 1, 2022 Accepting new patients
Chino Hills Optometry Inc Optometrist CurrentSince Nov 1, 2021 Accepting new patients
David G Kirschen OD PHD a Professional Optometric Corp Optometrist PastSince Feb 15, 2018 Accepting new patients
Dan B Tran Medical Corporation Optometrist PastSince Dec 3, 2021 Accepting new patients

Locations

4200 Chino Hills Pkwy
Ste 390
Chino Hills, CA 91709
Phone (909) 393-9058

7056 Archibald Ave
Ste 107
Eastvale, CA 92880
Phone (951) 898-8508

1700 Hamner Ave
Ste 102
Norco, CA 92860
Phone (951) 735-7122

1524 4th St
Ste 101
Norco, CA 92860
Phone (714) 771-1213

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1633478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633478400000",
    "number": "1225790322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2879 N WESTON ST",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928672286",
            "telephone_number": "714-595-4623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 CHINO HILLS PKWY STE 390",
            "city": "CHINO HILLS",
            "state": "CA",
            "postal_code": "917095825",
            "telephone_number": "909-393-9058",
            "fax_number": "909-393-7298"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "428 S Brea Blvd",
            "address_purpose": "LOCATION",
            "city": "Brea",
            "state": "CA",
            "postal_code": "928215301",
            "country_code": "US",
            "telephone_number": "714-529-2470",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHAM",
        "first_name": "TIFFANY",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-06",
        "last_updated": "2021-10-06",
        "certification_date": "2021-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "35028",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chino Hills, CA

Sources for this page

Verify at the official NPI Registry.