Active NPI
Michael T Pham, DMD
- Dentist
- Las Vegas, NV
National Provider Identifier
1619154507
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 4769
- Practice address
- 5905 S Eastern Ave Ste 112
Las Vegas, NV 89119-3130 - Phone
- (702) 262-5693
- Fax
- (702) 262-5693
- NPI assigned
- Jan 23, 2008
- Last updated
- Jun 8, 2015
- Sex
- Male
- 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 | 4769 | NV | Primary |
Addresses
Primary practice location
5905 S Eastern Ave Ste 112
Las Vegas, NV 89119-3130
Mailing address
5905 S Eastern Ave Ste 112
Las Vegas, NV 89119-3130
Phone (702) 262-5693
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 |
|---|---|---|---|
| 4769 | NV | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1201046400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1433721600000",
"number": "1619154507",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5905 S EASTERN AVE STE 112",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891193130",
"telephone_number": "702-262-5693",
"fax_number": "702-262-1301"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5905 S EASTERN AVE STE 112",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891193130",
"telephone_number": "702-262-5693",
"fax_number": "702-262-5693"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAM",
"first_name": "MICHAEL",
"middle_name": "T",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-01-23",
"last_updated": "2015-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NV",
"license": "4769",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.