Phu Van, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

DN20156 Issued in FL

Practice address

2050 Old Hickory Tree Rd
Saint Cloud, FL 34772-8926

Phone

(954) 579-1843

NPI assigned

Jun 18, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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

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

{
    "created_epoch": "1371513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654473600000",
    "number": "1982043451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 SW 94TH TER",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330251152",
            "telephone_number": "813-381-5632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2050 OLD HICKORY TREE RD",
            "city": "SAINT CLOUD",
            "state": "FL",
            "postal_code": "347728926",
            "telephone_number": "954-579-1843"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "511 W Brandon Blvd",
            "address_purpose": "LOCATION",
            "city": "Brandon",
            "state": "FL",
            "postal_code": "335115003",
            "country_code": "US",
            "telephone_number": "813-381-5632",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAN",
        "first_name": "PHU",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-18",
        "last_updated": "2022-06-06",
        "certification_date": "2022-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN20156",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Valerie Cruz
• Merylyn Yurley Valero Reyes
• Atabex Valles-Sanchez, LMFT
• Jennifer T. Van, DMD
• Jim Van, DDS
• Michelle Varela-Rosario, DC
• Luis Angel Vargas-Massari, MD
• Samantha R Vargas
• Yasmine Nicole Vargas, BCBA
• Sarah Jeannette Vasquez-Ramos

• Dentist in Saint Cloud, FL
• Providers in Saint Cloud, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2022; 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.