Active NPI
Nhung Phan, DMD
- General Practice Dentistry
- Las Vegas, NV
National Provider Identifier
1396397378
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 7211
- Practice address
- 4380 Blue Diamond Rd Ste 102
Las Vegas, NV 89139-7786 - Phone
- (702) 425-4424
- NPI assigned
- Jul 10, 2019
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 7211 | NV | Primary |
Addresses
Primary practice location
4380 Blue Diamond Rd Ste 102
Las Vegas, NV 89139-7786
Mailing address
1545 Wigwam Pkwy Apt 2522
Henderson, NV 89074-8288
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 |
|---|---|---|---|
| 7211 | NV | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Watanabe Diamond Dental Group, Professional Corporation | General Practice | Past | Accepting new patients |
| Pacific Dental Services | General Practice | Past | Accepting new patients |
Interoperability endpoints
- https://epicproxy.et1079.epichosted.com/FHIRProxy/api/FHIR/R4/
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.
-
- General Practice Dentistry
- Las Vegas, NV
- NPI 1588842702
General Practice
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1562716800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1562716800000",
"number": "1396397378",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1545 WIGWAM PKWY APT 2522",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890748288"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4380 BLUE DIAMOND RD STE 102",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891397786",
"telephone_number": "702-425-4424"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "NHUNG",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-07-10",
"last_updated": "2019-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NV",
"license": "7211",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.