Bruce Long-Tan Phung, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

47548 Issued in CA

Practice address

3817 Grand Ave
Suite D
Chino, CA 91710-5443

Phone

(909) 613-1970

Fax

(909) 613-1972

NPI assigned

Jun 2, 2008

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1212364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212364800000",
    "number": "1255590592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3817 GRAND AVE",
            "address_2": "SUITE D",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917105443",
            "telephone_number": "909-613-1970",
            "fax_number": "909-613-1972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3817 GRAND AVE",
            "address_2": "SUITE D",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917105443",
            "telephone_number": "909-613-1970",
            "fax_number": "909-613-1972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHUNG",
        "first_name": "BRUCE",
        "middle_name": "LONG-TAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-02",
        "last_updated": "2008-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "47548",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chloe Mai Pham
• Christopher Pham, DDS, MS
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• Kathy G Phillips, LMFT
• Phoenix Therapy
• Duong Thieu Phung, M.D.
• Pier Anesthesia Group, Inc.
• Christopher Martin Pike, PA
• Anthony Maurice Pinner, P.A-C
• Skye Krysten Pizarro

• General Practice Dentistry in Chino, CA
• Providers in Chino, 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 Jun 2, 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.