Active NPI
Kathy Nguyen-Pham
- Physician Assistant
- San Diego, CA
National Provider Identifier
1043095862
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 66024
- Practice address
- 4060 Fourth Ave Ste 505
San Diego, CA 92103-2121 - Phone
- (619) 298-1318
- Fax
- (619) 298-0843
- NPI assigned
- Aug 29, 2023
- Last updated
- May 23, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 66024 | CA | Primary |
Addresses
Primary practice location
4060 Fourth Ave Ste 505
San Diego, CA 92103-2121
Mailing address
4060 Fourth Ave Ste 505
San Diego, CA 92103-2121
Phone (619) 298-1318
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
4060 4TH Ave
Suite 505
San Diego, CA 92103-2121
Phone (619) 298-1318
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 66024 | CA | MD | Recreation Therapist |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/AEAABA/Endpoint/AEAABA
Organizations & group practices 1
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.
-
- Internal Medicine Physician
- San Diego, CA
- NPI 1912003252
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1693267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1747958400000",
"number": "1043095862",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4060 FOURTH AVE STE 505",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921032121",
"telephone_number": "619-298-1318",
"fax_number": "619-298-0843"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4060 FOURTH AVE STE 505",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921032121",
"telephone_number": "619-298-1318",
"fax_number": "619-298-0843"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NGUYEN-PHAM",
"first_name": "KATHY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-08-29",
"last_updated": "2025-05-23",
"certification_date": "2025-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "66024",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2025; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.