Cameron Phen

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

019.035342 Issued in IL

Practice address

688 Cabra St
Lincoln, CA 95648-8841

Phone

(916) 899-8386

NPI assigned

May 15, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

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

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: cphen171097@uihealth.direct-ci.com

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

{
    "created_epoch": "1684108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720483200000",
    "number": "1750072435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "688 CABRA ST",
            "city": "LINCOLN",
            "state": "CA",
            "postal_code": "956488841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "688 CABRA ST",
            "city": "LINCOLN",
            "state": "CA",
            "postal_code": "956488841",
            "telephone_number": "916-899-8386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHEN",
        "first_name": "CAMERON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-15",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D11858",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IL",
            "license": "019.035342",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lori Ann Peterson, PT
• Anthony Petraki
• Dara Lyn Pfeiffer
• Benjamin Van Pham, M.D.
• Phen Dental Professional Corporation
• Christopher Phen, D.D,S
• Jordan Phen, DDS
• Mark David Porco, D.D.S.
• Roxanne Dionisio Portugal, OTRL
• Ashley Jean Potts, BSW

• Student in an Organized Health Care Education/Training Program in Lincoln, CA
• Providers in Lincoln, CA by specialty
• Student in an Organized Health Care Education/Training Program in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2024; 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.

Verify at the official NPI Registry.