Fucong Tian, BDS, PHD

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

0401418375 Issued in VA

Practice address

12040 W Broad Street
Henrico, VA 23233

Phone

(804) 364-7010

Fax

(706) 721-6778

NPI assigned

May 17, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Dec 6, 2023 through Dec 6, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• Virginia Family Dentistry PC

  • General Practice Dentistry
  • Midlothian, VA
  • NPI 1750435970
  NPD (past)

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

{
    "created_epoch": "1526515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720483200000",
    "number": "1992295646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1612 HUGUENOT ROAD",
            "city": "MIDLOTHIAN",
            "state": "VA",
            "postal_code": "23113",
            "telephone_number": "804-794-9789",
            "fax_number": "804-419-1059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12040 W BROAD STREET",
            "city": "HENRICO",
            "state": "VA",
            "postal_code": "23233",
            "telephone_number": "804-364-7010",
            "fax_number": "706-721-6778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIAN",
        "first_name": "FUCONG",
        "name_prefix": "Dr.",
        "credential": "BDS, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-17",
        "last_updated": "2024-07-09",
        "certification_date": "2023-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "WA",
            "license": "DE61171559",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "TX",
            "license": "37946",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "GA",
            "license": "DNF000434",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "VA",
            "license": "0401418375",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZX0434",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003241248A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jasmine Omega Thompson
• Kziah Thompson, RBT
• Chartrice Thorne
• Gwendolyn B Thornton, PHD, LCSW
• Nancy H Thornton
• Kate Tucker Tibbs, PMH-NP
• William Andrew Tierney, MD
• Kimberly Tillar
• Lucy Timmins
• Titi Medical Transportation LLC

• Endodontics in Henrico, VA
• Providers in Henrico, VA by specialty
• Endodontics in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2024; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.