Pauline Pham Wong, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

53643 Issued in CA

Practice address

3811 Bedford Canyon Rd Ste 105
Corona, CA 92883-0789

Phone

(951) 270-0211

Fax

(951) 270-0702

NPI assigned

Mar 24, 2008

Last updated

Mar 24, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Pauline Pham Professional name

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

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wong & Pham DDS, Inc.

  dba Eagle Glen Dental Group

  • General Practice Dentistry
  • Corona, CA
  • NPI 1417128034
  NPD (past) Authorized official
• Sang C Paik DDS

  • Dentist
  • Corona, CA
  • NPI 1497979280
  NPD (past)

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

{
    "created_epoch": "1206316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206316800000",
    "number": "1396917936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27250",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928090297",
            "telephone_number": "951-270-0211",
            "fax_number": "951-270-0702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3811 BEDFORD CANYON RD STE 105",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928830789",
            "telephone_number": "951-270-0211",
            "fax_number": "951-270-0702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONG",
        "first_name": "PAULINE",
        "middle_name": "PHAM",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-03-24",
        "last_updated": "2008-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "53643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PAULINE",
            "last_name": "PHAM",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Wong & Pham DDS, Inc. (Eagle Glen Dental Group)
• David J. Loh Wong, D.D.S.
• Felix King Lok Wong, OD
• Gavin Wong, PHARMCIST
• Jimmy F Wong, PHARM D
• Queenie Wong, PHARMD
• Wilson Wong, RPH
• Tameira Woods-Bellamy
• Allegra Woods
• Craig Cameron Woods

• Dentist in Corona, CA
• Providers in Corona, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2008; 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.