Nicole B. Pham, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

39320 Issued in CA

Practice address

1788 S San Gabriel Blvd
#103
San Gabriel, CA 91776-3978

Phone

(626) 203-7553

Fax

(626) 445-8126

NPI assigned

Aug 27, 2009

Last updated

Aug 27, 2009By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1251331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1251331200000",
    "number": "1619100468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "888 SAN VICENTE RD",
            "city": "ARCADIA",
            "state": "CA",
            "postal_code": "910076038",
            "telephone_number": "626-203-7553",
            "fax_number": "626-445-8126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1788 S SAN GABRIEL BLVD",
            "address_2": "#103",
            "city": "SAN GABRIEL",
            "state": "CA",
            "postal_code": "917763978",
            "telephone_number": "626-203-7553",
            "fax_number": "626-445-8126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAM",
        "first_name": "NICOLE",
        "middle_name": "B.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-08-27",
        "last_updated": "2009-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "39320",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Pennington
• Cristina Maria Perez, LMFT
• Peter Hor-Tao Chiu
• Alexander Julian Pham, SLP
• Nam Pham, DO
• Elaine Hang Phan, MA, BCBA
• Jennifer Phan
• Pharmmed Inc (Las Tunas Pharmacy)
• Phi Tran Dental Corporation
• Lewis Phun

• General Practice Dentistry in San Gabriel, CA
• Providers in San Gabriel, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2009; 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.