Active NPI
Janet Pham
- Pharmacist
- Grand Terrace, CA
National Provider Identifier
1902688989
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 57789
- Practice address
- 11980 Mount Vernon Ave
Grand Terrace, CA 92313-5172 - Phone
- (909) 864-1097
- Fax
- (909) 503-1218
- NPI assigned
- Oct 16, 2023
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 57789 | CA | Primary |
Addresses
Primary practice location
11980 Mount Vernon Ave
Grand Terrace, CA 92313-5172
Mailing address
11980 Mount Vernon Ave
Grand Terrace, CA 92313-5172
Phone (909) 864-1097
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 |
|---|---|---|---|
| 57789 | CA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1697414400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1697414400000",
"number": "1902688989",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11980 MOUNT VERNON AVE",
"city": "GRAND TERRACE",
"state": "CA",
"postal_code": "923135172",
"telephone_number": "909-864-1097",
"fax_number": "909-503-1218"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11980 MOUNT VERNON AVE",
"city": "GRAND TERRACE",
"state": "CA",
"postal_code": "923135172",
"telephone_number": "909-864-1097",
"fax_number": "909-503-1218"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAM",
"first_name": "JANET",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-10-16",
"last_updated": "2023-10-16",
"certification_date": "2023-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "57789",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Terrace, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.