Active NPI
Nhu Phan, DDS
- Dentist
- Memphis, TN
National Provider Identifier
1588301105
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 11817
- Practice address
- 875 Union Ave
Memphis, TN 38103-3513 - Phone
- (901) 448-1461
- NPI assigned
- May 16, 2022
- Last updated
- May 16, 2022
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 11817 | TN | Primary |
Addresses
Primary practice location
875 Union Ave
Memphis, TN 38103-3513
Mailing address
1195 Harbor River Dr
Memphis, TN 38103-8973
Phone (501) 772-2761
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 |
|---|---|---|---|
| 11817 | TN | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652659200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652659200000",
"number": "1588301105",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1195 HARBOR RIVER DR",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381038973",
"telephone_number": "501-772-2761"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "875 UNION AVE",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381033513",
"telephone_number": "901-448-1461"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "NHU",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-05-16",
"last_updated": "2022-05-16",
"certification_date": "2022-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TN",
"license": "11817",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Memphis, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.