Active NPI
Jacqueline Tuyen Pham, DMD
- General Practice Dentistry
- Chamblee, GA
National Provider Identifier
1609096049
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN0112567
- Practice address
- 4649 Buford Hwy
Chamblee, GA 30341 - Phone
- (770) 452-1400
- NPI assigned
- Apr 26, 2007
- 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 | DN0112567 | GA | Primary |
Addresses
Primary practice location
4649 Buford Hwy
Chamblee, GA 30341
Mailing address
4649 Buford Hwy
Chamblee, GA 30341
Phone (770) 452-1400
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00787333 | Medicaid | GA | |
| 677H | Other | GA | DORAL |
| 101189 | Other | GA | PEACH STATE |
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 |
|---|---|---|---|
| DN0112567 | GA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1609096049",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4649 BUFORD HWY",
"city": "CHAMBLEE",
"state": "GA",
"postal_code": "30341",
"telephone_number": "770-452-1400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4649 BUFORD HWY",
"city": "CHAMBLEE",
"state": "GA",
"postal_code": "30341",
"telephone_number": "770-452-1400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAM",
"first_name": "JACQUELINE",
"middle_name": "TUYEN",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "DN0112567",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00787333",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DORAL",
"identifier": "677H",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PEACH STATE",
"identifier": "101189",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chamblee, GA
- Peak Performance Chiropractic and Rehabilitation, LLC
- Ralph D Peeler III, MD
- Perimeter Pediatrics
- Margaret Grace Peterson, RD
- Sandra Petrakis-Childs, L.C.S.W., L.M.F.T.
- Elaine Marie Poirier-Elliott, PNP
- Mary Elizabeth Powell, NP
- Premier Family Clinic
- Publix Super Markets, Inc.
- Kay Starr Rachelson, L.C.S.W.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.