Active NPI
Phil Han, DMD
- General Practice Dentistry
- Tigard, OR
National Provider Identifier
1548600695
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D10046
- Practice address
- 11820 SW King James Place Suite 20
Tigard, OR 97224 - Phone
- (503) 968-2901
- Fax
- (503) 406-4988
- NPI assigned
- Jul 2, 2013
- Sex
- Male
- 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 | D10046 | OR | Primary |
Addresses
Primary practice location
11820 SW King James Place Suite 20
Tigard, OR 97224
Mailing address
11820 SW King James PL Ste 20
Tigard, OR 97224-2481
Phone (503) 296-2901
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 |
|---|---|---|---|
| D10046 | OR | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tigard Family Dental, PC | General Practice | 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 and National Provider Directory roles.
-
- General Practice Dentistry
- Tigard, OR
- NPI 1205135118
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1372723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410220800000",
"number": "1548600695",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11820 SW KING JAMES PL STE 20",
"city": "TIGARD",
"state": "OR",
"postal_code": "972242481",
"telephone_number": "503-296-2901",
"fax_number": "503-406-4988"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11820 SW KING JAMES PLACE SUITE 20",
"city": "TIGARD",
"state": "OR",
"postal_code": "97224",
"telephone_number": "503-968-2901",
"fax_number": "503-406-4988"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAN",
"first_name": "PHIL",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-07-02",
"last_updated": "2014-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OR",
"license": "D10046",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tigard, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 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.