Sheena Phan-Wu

Primary specialty

DentistTaxonomy code 122300000X

License

61546 Issued in CA

Practice address

1100 Sonoma Ave
Suite a
Santa Rosa, CA 95405-8901

Phone

(707) 527-0363

Fax

(707) 527-6735

NPI assigned

Jun 21, 2013

Last updated

Jul 22, 2015By 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

Not listed in the public Medicare enrollment file

Opted out of Medicare

Previously, effective Aug 1, 2022 through Aug 1, 2026

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Sheena Phan-Wu D.D.S., Inc.

  dba San Mateo Dental Arts

  • Dental Clinic/Center
  • San Mateo, CA
  • NPI 1326775339
  NPD Authorized official
• Ellefson & Marelich Dental Corporation

  • Dentist
  • Santa Rosa, CA
  • NPI 1942728241
  NPD (past)

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

{
    "created_epoch": "1371772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437523200000",
    "number": "1235578386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 SONOMA AVE",
            "address_2": "SUITE A",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954058901",
            "telephone_number": "707-527-0363",
            "fax_number": "707-527-6735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 SONOMA AVE",
            "address_2": "SUITE A",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954058901",
            "telephone_number": "707-527-0363",
            "fax_number": "707-527-6735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN-WU",
        "first_name": "SHEENA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-06-21",
        "last_updated": "2015-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "61546",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marla Pfohl, RASI
• Cecilia Kimloan Pham
• Eric Minh-an Pham, PHARMD
• Jessica Pham
• Tai Minh Pham, MD/MPH
• Jennifer Kim Phan
• Tuan Quoc Phan, LVN
• Valerie Phan
• Makha Phetphommasouk
• Souliyo Phetsomphou

• Dentist in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.