Kim N Pham, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

52452 Issued in CA

Practice address

2205 Vesper Cir
#103
Corona, CA 92879-3501

Phone

(951) 737-5540

Fax

(951) 737-5549

NPI assigned

Nov 5, 2008

Last updated

Nov 5, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Kim Pham Yuan Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Mustafa Makati DDS a Professional Corp

  • Dentist
  • Corona, CA
  • NPI 1760259303
  NPD (past)

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

{
    "created_epoch": "1225843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1225843200000",
    "number": "1255585162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32610 SPUN COTTON DR",
            "city": "WINCHESTER",
            "state": "CA",
            "postal_code": "925968669",
            "telephone_number": "951-325-8805",
            "fax_number": "951-325-8805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2205 VESPER CIR",
            "address_2": "#103",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928793501",
            "telephone_number": "951-737-5540",
            "fax_number": "951-737-5549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAM",
        "first_name": "KIM",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-05",
        "last_updated": "2008-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "52452",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIM",
            "last_name": "YUAN",
            "middle_name": "PHAM",
            "prefix": "MRS.",
            "credential": "D.M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Salisha Peters, R.N.
• Amanda Peterson, DC
• Crystal Peterson
• Jessica Elizabeth Petty, D.O.
• David P Pham, D.O
• Shirley Pham, PHARMD
• Thuy Dich Pham, DO
• Tran Pham, PHARMD
• Vannessa Pham, HAD
• Ngoc Phan

• General Practice Dentistry in Corona, CA
• Providers in Corona, 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 Nov 5, 2008; 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.