Active NPI
Cindy Phan
- Dentist
- Boston, MA
National Provider Identifier
1225873334
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 113101
- Practice address
- 1 Kneeland St
Boston, MA 02111-1527 - Phone
- (617) 636-6828
- NPI assigned
- Jun 28, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 113101 | CA | Primary |
Addresses
Primary practice location
1 Kneeland St
Boston, MA 02111-1527
Mailing address
9641 Stanford Ave
Garden Grove, CA 92841-4942
Phone (714) 823-7978
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1719532800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1786838400000",
"number": "1225873334",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9641 STANFORD AVE",
"city": "GARDEN GROVE",
"state": "CA",
"postal_code": "928414942",
"telephone_number": "714-823-7978"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 KNEELAND ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021111527",
"telephone_number": "617-636-6828"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "CINDY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-06-28",
"last_updated": "2026-08-16",
"certification_date": "2026-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "113101",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.