Active NPI
Vyvy Pham, DDS
- Dentist
- Victorville, CA
National Provider Identifier
1396228458
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 103194
- Practice address
- 15290 Bear Valley Rd Ste B
Victorville, CA 92395-8515 - Phone
- (760) 493-3215
- NPI assigned
- Sep 13, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 103194 | CA | Primary |
Addresses
Primary practice location
15290 Bear Valley Rd Ste B
Victorville, CA 92395-8515
Mailing address
17230 Newhope St Apt 207
Fountain Valley, CA 92708-8212
Phone (949) 294-9081
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 103194 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1536796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1536796800000",
"number": "1396228458",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17230 NEWHOPE ST APT 207",
"city": "FOUNTAIN VALLEY",
"state": "CA",
"postal_code": "927088212",
"telephone_number": "949-294-9081"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15290 BEAR VALLEY RD STE B",
"city": "VICTORVILLE",
"state": "CA",
"postal_code": "923958515",
"telephone_number": "760-493-3215"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAM",
"first_name": "VYVY",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-09-13",
"last_updated": "2018-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "103194",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Victorville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.