Jason Thai Phan, D.D.S

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

58635 Issued in CA

Practice address

23451 Madison St
Ste 210
Torrance, CA 90505-4763

Phone

(310) 378-8342

Fax

(310) 378-4672

NPI assigned

Aug 14, 2009

Sex

Male

Sole proprietor

No

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

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jason Phan DDS Inc.

  dba Kuwahara and Phan Endodontics

  • Endodontics
  • Torrance, CA
  • NPI 1174981195
  NPD (past) Authorized official

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

{
    "created_epoch": "1250208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471392000000",
    "number": "1619109303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23451 MADISON ST",
            "address_2": "STE 210",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905054763",
            "telephone_number": "310-378-8342",
            "fax_number": "310-378-4672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23451 MADISON ST",
            "address_2": "STE 210",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905054763",
            "telephone_number": "310-378-8342",
            "fax_number": "310-378-4672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "JASON",
        "middle_name": "THAI",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-14",
        "last_updated": "2016-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "CA",
            "license": "58635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Quinton Pham, MD
• Tam N Pham, PHARM. D
• Vivian Thanh Pham, PHARMD
• Vy Xuan Pham
• Sharon Phamduong, DDS, MS
• Jonathan Phan
• Kristina Phan, DO
• Ryan Cao Vinh Phan, MD
• Trina Phan, PHARM.D
• Yen Phan

• Endodontics in Torrance, CA
• Providers in Torrance, CA by specialty
• Endodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2016; 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.

Verify at the official NPI Registry.