Active NPI
Huong Phan, DDS
- Dentist
- La Puente, CA
National Provider Identifier
1821674268
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DDS106051
- Practice address
- 15955 Main St
La Puente, CA 91744-4721 - Phone
- (626) 333-7022
- NPI assigned
- Mar 23, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 | DDS106051 | CA | Primary |
Addresses
Primary practice location
15955 Main St
La Puente, CA 91744-4721
Mailing address
2851 Monogram Ave
Long Beach, CA 90815-1537
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 |
|---|---|---|---|
| DDS106051 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616457600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1639440000000",
"number": "1821674268",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2851 MONOGRAM AVE",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908151537"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15955 MAIN ST",
"city": "LA PUENTE",
"state": "CA",
"postal_code": "917444721",
"telephone_number": "626-333-7022"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "HUONG",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-03-23",
"last_updated": "2021-12-14",
"certification_date": "2021-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "DDS106051",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Puente, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.