Active NPI
George G Pham, DDS
- General Practice Dentistry
- Santa Ana, CA
National Provider Identifier
1609915586
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 33107
- Practice address
- 1840 W 17TH St
Santa Ana, CA 92706-2319 - Phone
- (714) 972-9212
- NPI assigned
- Feb 6, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | 33107 | CA | Primary |
Addresses
Primary practice location
1840 W 17TH St
Santa Ana, CA 92706-2319
Mailing address
1840 W 17TH St
Santa Ana, CA 92706-2319
Phone (714) 972-9212
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160412000521 | CA | Order and Referring Only - Oral Surgery | 9830497635 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33107 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1609915586",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1840 W 17TH ST",
"city": "SANTA ANA",
"state": "CA",
"postal_code": "927062319",
"telephone_number": "714-972-9212"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1840 W 17TH ST",
"city": "SANTA ANA",
"state": "CA",
"postal_code": "927062319",
"telephone_number": "714-972-9212"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAM",
"first_name": "GEORGE",
"middle_name": "G",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "33107",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Ana, CA
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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.