Kim Phan, RDH

Primary specialty

Dental HygienistTaxonomy code 124Q00000X

License

DH60350549 Issued in WA

Practice address

1130 SW Morrison St Ste 450
Portland, OR 97205-2276

Phone

(503) 227-4410

NPI assigned

Apr 11, 2015

Sex

Female

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1428710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606435200000",
    "number": "1851787394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11410 SW LYNNVALE DRIVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97225",
            "telephone_number": "442-226-9053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 SW MORRISON ST STE 450",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972052276",
            "telephone_number": "503-227-4410"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14406 NE 20th Ave",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "986861448",
            "country_code": "US",
            "telephone_number": "800-813-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHAN",
        "first_name": "KIM",
        "credential": "RDH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-11",
        "last_updated": "2020-11-27",
        "certification_date": "2020-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "CA",
            "license": "27405",
            "primary": false
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "OR",
            "license": "H6453",
            "primary": false
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "WA",
            "license": "DH60350549",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Gia Son Phan, DMD
• Edward Nguyen Khoi Phan, PHARM.D
• Francis Thanh Phan, M.D.
• Hachau C Phan, AGACNP-BC
• Helen Phan
• Michael Phan, PHARMD
• Molly Sue Phan, O.D.
• Mona Tuong-Khanh Phan
• Nhu Y Sarah Phan, RN
• Phuong T Phan, PHARMD

• Dental Hygienist in Portland, OR
• Providers in Portland, OR by specialty
• Dental Hygienist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2020; 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.