Active NPI
Bang Tai Phan, D.D.S.
- General Practice Dentistry
- Porter Ranch, CA
National Provider Identifier
1851438154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 46927
- Practice address
- 11200 Corbin Ave
Suite 208
Porter Ranch, CA 91326-4120 - Phone
- (818) 368-8522
- Fax
- (818) 368-8544
- NPI assigned
- Jan 30, 2007
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 46927 | CA | Primary |
Addresses
Primary practice location
11200 Corbin Ave
Suite 208
Porter Ranch, CA 91326-4120
Mailing address
11200 Corbin Ave
Suite 208
Porter Ranch, CA 91326-4120
Phone (818) 368-8522
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Mar 5, 2018 through Mar 5, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 46927 | CA | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aleksei Dolgov DDS Inc | Past | Accepting new patients | |
| Phan Dental Corp. | Past | Accepting new patients |
Organizations & group practices 2
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.
-
dba Porter Ranch Dental Studio
- Dental Clinic/Center
- Porter Ranch, CA
- NPI 1134828148
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1851438154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11200 CORBIN AVE",
"address_2": "SUITE 208",
"city": "PORTER RANCH",
"state": "CA",
"postal_code": "913264120",
"telephone_number": "818-368-8522",
"fax_number": "818-368-8544"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11200 CORBIN AVE",
"address_2": "SUITE 208",
"city": "PORTER RANCH",
"state": "CA",
"postal_code": "913264120",
"telephone_number": "818-368-8522",
"fax_number": "818-368-8544"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "BANG",
"middle_name": "TAI",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "46927",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Porter Ranch, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.