Active NPI
Michael Ottwit Vongphoe, DDS.
- Dentist
- Rancho Cucamonga, CA
National Provider Identifier
1982897534
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 55928
- Practice address
- 9235 Timberline LN
Apt C
Rancho Cucamonga, CA 91730-6520 - Phone
- (909) 910-2929
- NPI assigned
- Aug 27, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 55928 | CA | Primary |
Addresses
Primary practice location
9235 Timberline LN
Apt C
Rancho Cucamonga, CA 91730-6520
Mailing address
9235 Timberline LN
Apt C
Rancho Cucamonga, CA 91730-6520
Phone (909) 910-2929
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150811006093 | CA | Order and Referring Only - Dentist | 7911212543 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1188172800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1188172800000",
"number": "1982897534",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9235 TIMBERLINE LN",
"address_2": "APT C",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "917306520",
"telephone_number": "909-910-2929"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9235 TIMBERLINE LN",
"address_2": "APT C",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "917306520",
"telephone_number": "909-910-2929"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VONGPHOE",
"first_name": "MICHAEL",
"middle_name": "OTTWIT",
"name_prefix": "Dr.",
"credential": "DDS.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-08-27",
"last_updated": "2007-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "55928",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rancho Cucamonga, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2007; 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.