The Tai Phan, DDS, MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

55427 Issued in CA

Practice address

11200 Corbin Ave
Suite #208
Porter Ranch, CA 91326-4120

Phone

(818) 368-8522

NPI assigned

Jan 12, 2010

Last updated

Jun 23, 2012By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Aleksei Dolgov DDS Inc

  dba Porter Ranch Dental Studio

  • Dental Clinic/Center
  • Porter Ranch, CA
  • NPI 1134828148
  NPD (past)
• Phan Dental Corp.

  dba Porter Ranch Dental Studio

  • Dentist
  • Porter Ranch, CA
  • NPI 1649597170
  NPD (past)

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

{
    "created_epoch": "1263254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340409600000",
    "number": "1407186562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 CYMBIDIUM CIR",
            "city": "SOUTH SAN FRANCISCO",
            "state": "CA",
            "postal_code": "940802266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11200 CORBIN AVE",
            "address_2": "SUITE #208",
            "city": "PORTER RANCH",
            "state": "CA",
            "postal_code": "913264120",
            "telephone_number": "818-368-8522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "THE",
        "middle_name": "TAI",
        "credential": "DDS, MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-01-12",
        "last_updated": "2012-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "55427",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Partridge Family Homes
• Phan Dental Corp. (Porter Ranch Dental Studio)
• Amanda Quynh Phan
• Bang Tai Phan, D.D.S.
• Sung Phan, R.PH
• Ami Thakor Philipp, M.D.
• Anahita Pirnazari
• Kesia Tijuan Pitt, H.I.S.
• Porter Ranch Congregate Living Inc
• Porter Ranch Integrative Medical Clinic, a Professional Corporation

• Oral and Maxillofacial Surgery (Dentist) in Porter Ranch, CA
• Providers in Porter Ranch, 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 Jun 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.