Khanh Phan, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

20392 Issued in TX

Practice address

5708 Colleyville Blvd
Ste. a
Colleyville, TX 76034-6064

Phone

(817) 428-8575

NPI assigned

Oct 5, 2011

Last updated

Oct 5, 2011By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Healthy Smiles 4 Kids, PC

  • Dentist
  • Colleyville, TX
  • NPI 1952778862
  NPD (past)

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

{
    "created_epoch": "1317772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317772800000",
    "number": "1770867020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "724 SAXON TRL",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760927704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5708 COLLEYVILLE BLVD",
            "address_2": "STE. A",
            "city": "COLLEYVILLE",
            "state": "TX",
            "postal_code": "760346064",
            "telephone_number": "817-428-8575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "KHANH",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-05",
        "last_updated": "2011-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "20392",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "DDS 49187",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pelican Medical Marketing LLC
• Sankar Pemmaraju, D.O.
• Kendall Peterson, M.S CCC-SLP
• Pham Pena PLLC
• Fortsmith Pham, O.D.
• Justus Varghese Philip, M.D.
• T'Airra Phillips
• Paulina Phommahaxay
• Physicians Data LLC
• Physicians Medical Data and Research Inc

• General Practice Dentistry in Colleyville, TX
• Providers in Colleyville, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.