Individual provider Active NPI

Chonway Daly Tram, DDS

  • General Practice Dentistry
  • Costa Mesa, CA
National Provider Identifier
1851545537
Registry record updated Oct 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
57681 Issued in CA
Practice address
230 E 17TH St
Suite 208
Costa Mesa, CA 92627-3824
Phone
(949) 645-0045
NPI assigned
Nov 8, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 57681 CA Primary

Addresses

Primary practice location

230 E 17TH St
Suite 208
Costa Mesa, CA 92627-3824

Mailing address

230 E 17TH St
Suite 208
Costa Mesa, CA 92627-3824
Phone (949) 645-0045

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20150713001522 CA Order and Referring Only - DentistPractitioner - Dentist 0840503330

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
JJ Kim Dental Corporation PastSince Mar 12, 2023 Accepting new patients
Costa Mesa 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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1226102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1256860800000",
    "number": "1851545537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 E 17TH ST",
            "address_2": "SUITE 208",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926273824",
            "telephone_number": "949-645-0045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 E 17TH ST",
            "address_2": "SUITE 208",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926273824",
            "telephone_number": "949-645-0045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAM",
        "first_name": "CHONWAY",
        "middle_name": "DALY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-11-08",
        "last_updated": "2009-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "57681",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Costa Mesa, CA

Sources for this page

Verify at the official NPI Registry.