Active NPI
Jeremy Huy Pham, DDS
- Dentist
- Moreno Valley, CA
National Provider Identifier
1679912281
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 62428
- Practice address
- 22675 Alessandro Blvd
Moreno Valley, CA 92553-8551 - Phone
- (951) 571-2365
- NPI assigned
- Jun 17, 2013
- 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 | 62428 | CA | Primary |
Addresses
Primary practice location
22675 Alessandro Blvd
Moreno Valley, CA 92553-8551
Mailing address
821 Ranch Vista Rd
Corona, CA 92879-7750
Phone (909) 217-2676
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160726001877 | CA | Order and Referring Only - Oral Surgery | 7113210329 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 62428 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1371427200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374624000000",
"number": "1679912281",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "821 RANCH VISTA RD",
"city": "CORONA",
"state": "CA",
"postal_code": "928797750",
"telephone_number": "909-217-2676"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22675 ALESSANDRO BLVD",
"city": "MORENO VALLEY",
"state": "CA",
"postal_code": "925538551",
"telephone_number": "951-571-2365"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAM",
"first_name": "JEREMY",
"middle_name": "HUY",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-06-17",
"last_updated": "2013-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "62428",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moreno Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2013; 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.