Active NPI
Thuy N. Pham
- Dentist
- Antioch, CA
National Provider Identifier
1659419752
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 54298
- Practice address
- 2590 Sycamore Dr
Antioch, CA 94509-2909 - Phone
- (925) 776-1140
- Fax
- (925) 776-1148
- NPI assigned
- Feb 1, 2007
- Sex
- Female
- 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 | 54298 | CA | Primary |
Addresses
Primary practice location
2590 Sycamore Dr
Antioch, CA 94509-2909
Mailing address
216 Devonshire CT
Pleasant Hill, CA 94523-2079
Phone (925) 776-1140
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D54298 | Medicaid | CA |
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 |
|---|---|---|---|
| 54298 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Western Dental Services, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Practice Dentistry
- Antioch, CA
- NPI 1659427771
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170288000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1659419752",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "216 DEVONSHIRE CT",
"city": "PLEASANT HILL",
"state": "CA",
"postal_code": "945232079",
"telephone_number": "925-776-1140",
"fax_number": "714-571-3560"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2590 SYCAMORE DR",
"city": "ANTIOCH",
"state": "CA",
"postal_code": "945092909",
"telephone_number": "925-776-1140",
"fax_number": "925-776-1148"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAM",
"first_name": "THUY",
"middle_name": "N.",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-01",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "54298",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "D54298",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Antioch, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.