Active NPI
Lan Bich Nguyen, DDS
- General Practice Dentistry
- Phoenix, AZ
National Provider Identifier
1447339064
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D5809
- Practice address
- 1904 W Parkside LN
Suite 201
Phoenix, AZ 85027-1228 - Phone
- (623) 434-9343
- Fax
- (623) 321-6268
- NPI assigned
- Nov 3, 2006
- Last updated
- Mar 14, 2016
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D5809 | AZ | Primary |
Addresses
Primary practice location
1904 W Parkside LN
Suite 201
Phoenix, AZ 85027-1228
Mailing address
1701 E Thomas Rd
Ste 204
Phoenix, AZ 85016-7675
Phone (602) 253-6600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 785719 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160318002213 | AZ | Order and Referring Only - Oral Surgery | 2163729047 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D5809 | AZ | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pda Holdings West, LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1457913600000",
"number": "1447339064",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1701 E THOMAS RD",
"address_2": "STE 204",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850167675",
"telephone_number": "602-253-6600",
"fax_number": "602-733-6480"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1904 W PARKSIDE LN",
"address_2": "SUITE 201",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850271228",
"telephone_number": "623-434-9343",
"fax_number": "623-321-6268"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NGUYEN",
"first_name": "LAN",
"middle_name": "BICH",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-03",
"last_updated": "2016-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AZ",
"license": "D5809",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "785719",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2016; 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.