Individual provider Active NPI

Holly DO Nguyen, D.M.D.

  • Pediatric Dentistry
  • Philadelphia, PA
National Provider Identifier
1619258969
Registry record updated Dec 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
DS038673 Issued in PA
Practice address
2301 E Allegheny Ave Ste 201
Philadelphia, PA 19134-4427
Phone
(215) 282-8000
NPI assigned
Aug 31, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DS038673 PA
Pediatric Dentistry 1223P0221X 22DI02484700 NJ
Pediatric Dentistry 1223P0221X DS038673 PA Primary

Addresses

Primary practice location

2301 E Allegheny Ave Ste 201
Philadelphia, PA 19134-4427

Mailing address

3101 Parkview Walk
Philadelphia, PA 19125-4360
Phone (215) 327-6048

Other practice location 1

805 Route 38
Cherry Hill, NJ 08002-2850
Phone (856) 281-7600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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

Enrollment IDStateProvider typePAC IDDetails
I20180328002267 PA Order and Referring Only - DentistPractitioner - Dentist 5294097499

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
22DI02484700NJMDPediatric Dentist

NPI Registry JSON

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

{
    "created_epoch": "1314748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733270400000",
    "number": "1619258969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3101 PARKVIEW WALK",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191254360",
            "telephone_number": "215-327-6048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 E ALLEGHENY AVE STE 201",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191344427",
            "telephone_number": "215-282-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "805 Route 38",
            "address_purpose": "LOCATION",
            "city": "Cherry Hill",
            "state": "NJ",
            "postal_code": "080022850",
            "country_code": "US",
            "telephone_number": "856-281-7600",
            "fax_number": "856-281-7604",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DO NGUYEN",
        "first_name": "HOLLY",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-31",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS038673",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NJ",
            "license": "22DI02484700",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "PA",
            "license": "DS038673",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.