Bennie Van Pham, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

58021 Issued in CA

Practice address

18426 Brookhurst St Ste 101
Fountain Valley, CA 92708-6777

Phone

(714) 965-5255

NPI assigned

Dec 26, 2008

Last updated

Dec 11, 2019By the provider in NPPES

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 2

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

Medicare enrollment (NPD)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Hagen & Pham Dental Partnership

  • General Practice Dentistry
  • Fountain Valley, CA
  • NPI 1104462696
  NPD
• Peter E. Hagen, DDS, Inc

  • General Practice Dentistry
  • Fountain Valley, CA
  • NPI 1033595996
  NPD (past)

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

{
    "created_epoch": "1230249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576022400000",
    "number": "1891931762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8981 ACACIA AVE",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928414613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18426 BROOKHURST ST STE 101",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927086777",
            "telephone_number": "714-965-5255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAM",
        "first_name": "BENNIE",
        "middle_name": "VAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-12-26",
        "last_updated": "2019-12-11",
        "certification_date": "2019-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "054267",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "58021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA STATE DENTAL LICENSE",
            "identifier": "58021",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NY STATE DENTAL LICENSE",
            "identifier": "054267",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Josiah Paul Peterson
• Sarah G. Peterson
• Pham Physical Therapy Services Inc
• Alexander Hoang Pham, BT
• Alexander Minh Pham, DPT
• Cau X Pham, M.D.
• Christine Pham, PHARMD
• Debbie D Pham, PHARMD
• Diana Pham
• Dieu Quang Pham, M.D., D.D.S.

• Dentist in Fountain Valley, CA
• Providers in Fountain Valley, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2019; 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.