Lee Duong Pham, DDS, MD, MS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

55453 Issued in CA

Practice address

4582 Katella Ave
Los Alamitos, CA 90720-2655

Phone

(562) 598-4683

Fax

(562) 598-4693

NPI assigned

Feb 5, 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

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Master of Science

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 and National Provider Directory roles.

• Costa Mesa Oral Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Costa Mesa, CA
  • NPI 1598347510
  NPD Authorized official
• Sanford L. Ratner DDS and Monty C.Wilson DDS Inc.

  • Oral and Maxillofacial Surgery (Dentist)
  • Santa Ana, CA
  • NPI 1154514388
  NPD

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

{
    "created_epoch": "1202169600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619568000000",
    "number": "1386822971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4582 KATELLA AVE",
            "city": "LOS ALAMITOS",
            "state": "CA",
            "postal_code": "907202655",
            "telephone_number": "562-598-4683",
            "fax_number": "562-598-4693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4582 KATELLA AVE",
            "city": "LOS ALAMITOS",
            "state": "CA",
            "postal_code": "907202655",
            "telephone_number": "562-598-4683",
            "fax_number": "562-598-4693"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "58 Tesoro",
            "address_purpose": "LOCATION",
            "city": "Irvine",
            "state": "CA",
            "postal_code": "926180103",
            "country_code": "US",
            "telephone_number": "310-849-4690",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHAM",
        "first_name": "LEE",
        "middle_name": "DUONG",
        "name_prefix": "Dr.",
        "credential": "DDS, MD, MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-02-05",
        "last_updated": "2021-04-28",
        "certification_date": "2021-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "55453",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Claire Peters
• Christi Ann Peterson, D.M.D.
• Petrichor Healing Family Therapy, Inc.
• Andrew Pham, DDS
• Kaylyn Bich Hong Pham, PHARMD
• Thanh T Pham, FNP-C
• Tina Thi Pham, PTA
• Vu Q. Phan, MD
• Phillip Cleaver Marriage and Family Therapy Inc
• Pih Health Physicians

• Oral and Maxillofacial Surgery (Dentist) in Los Alamitos, CA
• Providers in Los Alamitos, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.