Active NPI
Linh Phan
- General Practice Dentistry
- San Diego, CA
National Provider Identifier
1508286410
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 63015
- Practice address
- 11735 Wills Creek Rd
San Diego, CA 92131-3705 - Phone
- (347) 989-3345
- NPI assigned
- Apr 17, 2014
- Sex
- Female
- Sole proprietor
- No
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 | 63015 | CA | Primary |
Addresses
Primary practice location
11735 Wills Creek Rd
San Diego, CA 92131-3705
Mailing address
11735 Wills Creek Rd
San Diego, CA 92131-3705
Phone (347) 989-3345
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 63015 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1397692800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1397692800000",
"number": "1508286410",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11735 WILLS CREEK RD",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921313705",
"telephone_number": "347-989-3345"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11735 WILLS CREEK RD",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921313705",
"telephone_number": "347-989-3345"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "LINH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-04-17",
"last_updated": "2014-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "63015",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.