NPIMap

Organization Active NPI

Kevin Thang Pham, DDS, Inc.

  • General Practice Dentistry
  • Stockton, CA
National Provider Identifier
1578996286
Registry record updated Sep 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
48979 Issued in CA
Legal business name
KEVIN THANG PHAM, DDS, INC.
Practice address
7746 Lorraine Ave Suite 204
Stockton, CA 95210-4234
Phone
(209) 475-0869
Fax
(209) 475-0859
NPI assigned
Aug 16, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2021

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

Authorized official

Name
Kevin Thang Pham, DDSNPI 1003900705
Title
Owner
Phone
(209) 475-0869

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 48979 CA Primary

Addresses

Primary practice location

7746 Lorraine Ave Suite 204
Stockton, CA 95210-4234

Mailing address

7746 Lorraine Ave Suite 204
Stockton, CA 95210-4234
Phone (209) 475-0869

Other names 1

  • Kevin Thang Pham DDS PC Former legal business name

National Provider Directory

National Provider Directory

Locations

7746 Lorraine Ave
Ste 204
Stockton, CA 95210
Phone (209) 475-0869

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1376611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630540800000",
    "number": "1578996286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7746 LORRAINE AVE SUITE 204",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952104234",
            "telephone_number": "209-475-0869",
            "fax_number": "209-475-0859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7746 LORRAINE AVE SUITE 204",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952104234",
            "telephone_number": "209-475-0869",
            "fax_number": "209-475-0859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEVIN THANG PHAM, DDS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-16",
        "last_updated": "2021-09-02",
        "certification_date": "2021-09-02",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "THANG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "209-475-0869",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "48979",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kevin Thang Pham DDS PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Stockton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2021; 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.