NAM PHAN DMD INC NPI 1487976759

NPI Information

  • NPI: 1487976759
  • Provider Name: NAM PHAN, DMD, INC
  • Classification: Dentist - 1223G0001X
  • Specialization: General Practice
  • Entity Type: Organization
  • Doing Business As: PRO DENTISTA DENTAL GROUP
  • Address: 2634 CLARENDON AVE
    HUNTINGTON PARK, CA
    ZIP 90255
  • Phone: (323) 585-2777

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NPI Details

NAM PHAN, DMD, INC is a general practice dentist in Huntington Park, CA. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. NAM PHAN, DMD, INC NPI is 1487976759. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Pro Dentista Dental Group.

The provider's business location address is:

2634 CLARENDON AVE
HUNTINGTON PARK, CA
ZIP 90255-120
Phone: (323) 585-2777

The provider's authorized official is Teresa Hayrapetian .
The authorized official title is Consultant and has the following contact phone number (818) 262-6114.

The enumeration date for this NPI number is 2/26/2010 and was last updated on 2/26/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223G0001XDentistGeneral PracticeYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11881924298MEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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