Individual provider Active NPI

Vinh Canh Nguyen-Phuoc, DMD

  • General Practice Dentistry
  • Portland, OR
National Provider Identifier
1386877934
Registry record updated Sep 26, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D9315 Issued in OR
Practice address
1102 NE 82ND Ave
Portland, OR 97220-5701
Phone
(503) 408-8926
NPI assigned
Aug 31, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D9315 OR Primary

Addresses

Primary practice location

1102 NE 82ND Ave
Portland, OR 97220-5701

Mailing address

1102 NE 82ND Ave
Portland, OR 97220-5701
Phone (503) 408-8927

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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

Enrollment IDStateProvider typePAC IDDetails
I20151002002421 OR Order and Referring Only - DentistPractitioner - Dentist 7810205341

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Mva Dental LLC General Practice Past Accepting new patients
Pacific Dental Care P.C. General Practice Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1251676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285459200000",
    "number": "1386877934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1102 NE 82ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972205701",
            "telephone_number": "503-408-8927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 NE 82ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972205701",
            "telephone_number": "503-408-8926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN-PHUOC",
        "first_name": "VINH",
        "middle_name": "CANH",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-31",
        "last_updated": "2010-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D9315",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.