Active NPI
Phuoc Huu Phan, DDS
- Endodontics
- Irvine, CA
National Provider Identifier
1861500480
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 45401
- Practice address
- 3 Grass Vly
Irvine, CA 92602-1098 - Phone
- (714) 665-9260
- NPI assigned
- Aug 25, 2006
- 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 45401 | CA | Primary |
Addresses
Primary practice location
3 Grass Vly
Irvine, CA 92602-1098
Mailing address
3 Grass Vly
Irvine, CA 92602-1098
Phone (714) 665-9260
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 |
|---|---|---|---|
| 45401 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156464000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1861500480",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 GRASS VLY",
"city": "IRVINE",
"state": "CA",
"postal_code": "926021098",
"telephone_number": "714-665-9260"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 GRASS VLY",
"city": "IRVINE",
"state": "CA",
"postal_code": "926021098",
"telephone_number": "714-665-9260"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "PHUOC",
"middle_name": "HUU",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "CA",
"license": "45401",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Irvine, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.