Gina Cuc Pham, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

0401411775 Issued in VA

Practice address

12602 Lake Ridge Dr
Woodbridge, VA 22192-2335

Phone

(703) 490-5050

Fax

(703) 490-1155

NPI assigned

Mar 13, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Dr. Gina Cuc Pham Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Gina C Pham DDS PC

  • Pediatric Dentistry
  • Woodbridge, VA
  • NPI 1801029590
  NPD Authorized official
• Shiningstars Pediatric Dentistry PC

  • Pediatric Dentistry
  • Washington, DC
  • NPI 1659882595
  NPD Authorized official
• Shiningstars Pediatric Dentistry PC

  • Pediatric Dentistry
  • Washington, DC
  • NPI 1922738848
  NPD Authorized official

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615939200000",
    "number": "1861525818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10083",
            "city": "MC LEAN",
            "state": "VA",
            "postal_code": "221028083",
            "telephone_number": "703-626-8196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12602 LAKE RIDGE DR",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221922335",
            "telephone_number": "703-490-5050",
            "fax_number": "703-490-1155"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "435 Ingraham St NE",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "DC",
            "postal_code": "200112605",
            "country_code": "US",
            "telephone_number": "202-600-4833",
            "fax_number": "202-635-5555",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13900 Noblewood Plz",
            "address_purpose": "LOCATION",
            "city": "Woodbridge",
            "state": "VA",
            "postal_code": "221931449",
            "country_code": "US",
            "telephone_number": "703-490-5050",
            "fax_number": "571-589-8323",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHAM",
        "first_name": "GINA",
        "middle_name": "CUC",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-13",
        "last_updated": "2021-03-17",
        "certification_date": "2021-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MD",
            "license": "13454",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "DC",
            "license": "DEN1001433",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "VA",
            "license": "0401411775",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GINA",
            "last_name": "PHAM",
            "middle_name": "CUC",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Persevere Residential Services
• Peter a Bryce MD PC
• Peter HD Kim, DDS
• Izabella Petrescu
• Gregory Scott Petruzzi, D.C.
• Nhu-Oanh Thi Pham, PHARMD
• Shawn Ngoc Pham, MSW, LCSW
• Teresa Diemtu Pham, O.D.
• Linh Phan, DDS
• Thoaivan Phan, D.D.S

• Pediatric Dentistry in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Pediatric Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.

Verify at the official NPI Registry.