Individual provider Active NPI

Tuan Pham, D.M.D.

  • Dentist
  • Vienna, VA
National Provider Identifier
1720206451
Registry record updated Sep 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
0401410688 Issued in VA
Practice address
307 Maple Ave W Ste M
Vienna, VA 22180-4307
Phone
(703) 281-1090
NPI assigned
Apr 20, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 0401410688 VA Primary

Addresses

Primary practice location

307 Maple Ave W Ste M
Vienna, VA 22180-4307

Mailing address

307 Maple Ave W Ste M
Vienna, VA 22180-4307
Phone (703) 281-1090

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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
I20160415002087 MD Order and Referring Only - DentistPractitioner - Dentist 8729386297

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0401410688VAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Pham, Biga & Maloney, PLLC Dentist PastSince Sep 29, 2024 Accepting new patients
Rogowski and Maloney Partnership Dentist PastSince Sep 29, 2024 Accepting new patients
Tuan D Pham DMD & Joseph a Maloney DDS, LLC Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726963200000",
    "number": "1720206451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 MAPLE AVE W STE M",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221804307",
            "telephone_number": "703-281-1090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 MAPLE AVE W STE M",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221804307",
            "telephone_number": "703-281-1090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAM",
        "first_name": "TUAN",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-20",
        "last_updated": "2024-09-22",
        "certification_date": "2024-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401410688",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vienna, VA

Sources for this page

Verify at the official NPI Registry.