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1245643154 NPI number — MAI PHAM DMD

NPI Number: 1245643154
Health Care Provider/Practitioner: MAI PHAM DMD

Information about “1245643154” NPI (MAI PHAM DMD) exists in 1245643154 in HTML format HTML  |  1245643154 in plain Text format TXT  |  1245643154 in PDF (Portable Document Format) PDF  |  1245643154 in an XML format XML  formats.

NPI Number : 1245643154 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1245643154",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PHAM",
    "FirstName": "MAI",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2414 S FAIRVIEW ST",
    "SecondLineMailingAddress": "SUITE #101",
    "MailingAddressCityName": "SANTA ANA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92704-5318",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "714-617-4294",
    "MailingAddressFaxNumber": "714-242-4070",
    "FirstLinePracticeLocationAddress": "2414 S FAIRVIEW ST",
    "SecondLinePracticeLocationAddress": "SUITE #101",
    "PracticeLocationAddressCityName": "SANTA ANA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92704-5318",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "281-298-2433",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/09/2014",
    "LastUpdateDate": "12/28/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "122300000X",
          "TaxonomyName": "Dentist",
          "LicenseNumber": "29878",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1223G0001X",
          "TaxonomyName": "General Practice Dentistry",
          "LicenseNumber": "64449",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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