Kathleen Phung, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

311004 Issued in NY

Practice address

13743 45TH Ave
Flushing, NY 11355-4048

Phone

(929) 362-3006

Fax

(929) 362-3026

NPI assigned

Apr 16, 2018

Last updated

Jun 28, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H3359

Interoperability endpoints

• Direct secure messaging: kphung@1120.direct.myezyaccess.com
• Direct secure messaging: kphung787785@direct.ochin.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Charles B. Wang Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • New York, NY
  • NPI 1144203498
  NPD (past)
• Charles B. Wang Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • New York, NY
  • NPI 1417261298
  NPD (past)

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

{
    "created_epoch": "1523836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624838400000",
    "number": "1023505039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 WALKER ST FL 2",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100134135",
            "telephone_number": "212-226-8866",
            "fax_number": "212-226-2289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13743 45TH AVE",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113554048",
            "telephone_number": "929-362-3006",
            "fax_number": "929-362-3026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHUNG",
        "first_name": "KATHLEEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-16",
        "last_updated": "2021-06-28",
        "certification_date": "2021-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "311004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "311004",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Philam Physical Therapy PC
• Susan Phillips, NP
• Phoenix Care LLC
• Phoenix Care LLC
• Phoenix Wellness Acupuncture and Massage PC
• Physical Therapy of North Queens PC.,
• Debra Pianin
• Pick Me Up, Corp.
• Justin M Pick, M.D.
• John Albert Delfin Pielago

• Pediatrics Physician in Flushing, NY
• Providers in Flushing, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2021; 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.

Verify at the official NPI Registry.