Wong & Pham DDS, Inc.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

53643 Issued in CA

Legal business name

WONG & PHAM DDS, INC.

Doing business as

Eagle Glen Dental Group

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

Organization subpart

No

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

Authorized official

Name

Dr. Pauline Pham Wong, DDSNPI 1396917936

Title

President

Phone

(951) 270-0211

Specialties & licenses 1

Addresses

Other names 1

• Eagle Glen Dental Group Doing business as

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Pauline Pham Wong, DDS

  • Dentist
  • Corona, CA
  • NPI 1396917936
  NPD (past) Authorized official
• Stephen Chung Kim, DDS

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Corona, CA
  • NPI 1881832806
  NPD (past)
• Jimmy Bao Pham, DDS

  • General Practice Dentistry
  • Chino Hills, CA
  • NPI 1972791275
  NPD (past)

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

{
    "created_epoch": "1206316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206316800000",
    "number": "1417128034",
    "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": {
        "organization_name": "WONG & PHAM DDS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-24",
        "last_updated": "2008-03-24",
        "status": "A",
        "authorized_official_last_name": "WONG",
        "authorized_official_first_name": "PAULINE",
        "authorized_official_middle_name": "PHAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "951-270-0211",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "53643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eagle Glen Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jonathan Withers
• Christianne M Wolesky
• Women's Institute for Infertility and Reproductive Medicine
• Women's Institute for Intertility and Reproductive Medicne
• Womens Institute for Infertility and Reproductive Medicine a Med
• David J. Loh Wong, D.D.S.
• Felix King Lok Wong, OD
• Gavin Wong, PHARMCIST
• Jimmy F Wong, PHARM D
• Pauline Pham Wong, DDS

• General Practice Dentistry in Corona, CA
• Providers in Corona, CA by specialty
• General Practice Dentistry 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.