Phong Cam Ta, D.D.S.

Primary specialty

Dental AnesthesiologyTaxonomy code 1223D0004X

License

054360 Issued in NY

Practice address

410 W 53Rd St
Apt 126
New York, NY 10019-5622

Phone

(215) 527-8768

NPI assigned

Nov 5, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Dental Anesthesia of New York, LLC

  • Dental Anesthesiology
  • New York, NY
  • NPI 1437509841
  NPD (past) Authorized official

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

{
    "created_epoch": "1225843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466035200000",
    "number": "1861646747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 W 53RD ST",
            "address_2": "APT 126",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100195693",
            "telephone_number": "215-527-8768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 W 53RD ST",
            "address_2": "APT 126",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100195622",
            "telephone_number": "215-527-8768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TA",
        "first_name": "PHONG",
        "middle_name": "CAM",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-11-05",
        "last_updated": "2016-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "P65701",
            "primary": false
        },
        {
            "code": "1223D0004X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Anesthesiology",
            "state": "NY",
            "license": "054360",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03203894",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• T-RX Group LLC
• Ta-Day Bodyworks, Inc
• Brian Ta
• Kenny Ta
• My Huong K. Ta, DDS
• Roxanne Ta
• Sinh T Ta, DDS
• Yehuda Taavar
• Danielle L Tabachnick, DNP, FNP-BC
• Ariel Victoria Tabachnik, MD

• Dental Anesthesiology in New York, NY
• Providers in New York, NY by specialty
• Dental Anesthesiology in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.