Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1023632676 Individual Practitioner Male Practitioner

Derrick Anh Vo Pham , DENTAL STUDENT

Dentist • Oceanside, CA

Professional Overview & Biography Verified Profile Summary

Derrick Pham, DENTAL STUDENT is a registered healthcare professional specializing in Dentist in Oceanside, CA. Practice services are available at 92055 14TH STREET under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

92055 14th Street

Oceanside, CA 92058

Telephone 7607255870

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist in Oceanside, CA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 14.4 Yrs
Regional Practice Density
48 Specialists

Practicing in Oceanside, CA (15331 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2021-08-11
Dentist Primary Specialty

NUCC Taxonomy Code: 122300000X

State License CA 106380

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

Student in an Organized Health Care Education/Training Program

NUCC Taxonomy Code: 390200000X

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

Secondary Practice Locations

714 Tiverton Ave

Los Angeles, CA 900958361

Phone: 3108259789

Navy Medicine Support Command Attn: Medical Staff Svcs, Bldg H 2005 Knight Lane

Jacksonville, FL 322120140

Phone: 7607253213

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

12 Associated Practitioners
NPI 1003423260

Registered Dental Hygienist

Connie Good

Dental Hygienist

NPI 1194325597
NPI 1376432302

Doctor of Dental Medicine

Cynthia Knode , RDA

Dental Assistant

NPI 1396352555
NPI 1407428543

Doctor of Dental Medicine

Dora Young

Dental Assistant

NPI 1528675980

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

9 Historical Events
📍
Updated Practice Location August 30, 2021

Registered at 92055 14TH STREET, OCEANSIDE, CA 92058 (Tel: 7607255870)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) August 30, 2021

Dentist (License #106380 in CA)

📍
Updated Practice Location May 07, 2021

Registered at NAVY MEDICINE SUPPORT COMMAND ATTN: MEDICAL STAFF SVCS, BLDG H 2005 KNIGHT LANE, JACKSONVILLE, FL 322120140 (Tel: 7607253213)

NPI Profile Active May 29, 2020

NPI status registered as active in NPPES database

📍
Updated Practice Location May 29, 2020

Registered at 714 TIVERTON AVE, LOS ANGELES, CA 900958361 (Tel: 3108259789)

📍
Updated Business Mailing Address May 29, 2020

Registered at 4270 KIRKCALDY DR, SAN DIEGO, CA 921113621 (Tel: 8589991299)

👤
Provider Name / Credentials Updated May 29, 2020

Recorded as DERRICK PHAM, DENTAL STUDENT

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) May 29, 2020

Student in an Organized Health Care Education/Training Program

🟢
Initial NPI Registration & Enumeration May 29, 2020

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1023632676
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: May 29, 2020
Last Update: August 30, 2021
Sole Proprietor: No

Mailing Address

4270 Kirkcaldy Dr

San Diego, CA 921113621

Phone: 8589991299

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.