Active NPI
Trinh T Pham, D.D.S.
- Pediatric Dentistry
- Anaheim, CA
National Provider Identifier
1487886594
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 59266
- Practice address
- 2156 E Lincoln Ave
Anaheim, CA 92806-4104 - Phone
- (714) 399-3140
- NPI assigned
- Aug 24, 2009
- Last updated
- Nov 16, 2010
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 50054621 | NY | |
| Pediatric Dentistry | 1223P0221X | 59266 | CA | Primary |
Addresses
Primary practice location
2156 E Lincoln Ave
Anaheim, CA 92806-4104
Mailing address
1251 S Berkley St
Anaheim, CA 92804-4607
Phone (714) 310-0913
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160105002683 | CA | Order and Referring Only - Dentist | 9133421365 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50054621 | NY | MD | Pediatric Dentist |
| 59266 | CA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sorour D.M.D Corporation | Past | Accepting new patients | |
| Scott Jacks, DDS, Inc | Pediatric Dentistry | Past | Accepting new patients |
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, 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": "1251072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1289865600000",
"number": "1487886594",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1251 S BERKLEY ST",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928044607",
"telephone_number": "714-310-0913"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2156 E LINCOLN AVE",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928064104",
"telephone_number": "714-399-3140"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAM",
"first_name": "TRINH",
"middle_name": "T",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-08-24",
"last_updated": "2010-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "NY",
"license": "50054621",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "CA",
"license": "59266",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Anaheim, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2010; 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.