Individual provider Active NPI

Jonathan Pham, FNP-BC

  • Family Nurse Practitioner
  • Fountain Valley, CA
National Provider Identifier
1053298406
Registry record updated Aug 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95036371 Issued in CA
Practice address
17150 Euclid St Ste 200
Fountain Valley, CA 92708-4092
Phone
(714) 395-4595
NPI assigned
Aug 18, 2025
Last updated
Aug 18, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95036371 CA Primary

Addresses

Primary practice location

17150 Euclid St Ste 200
Fountain Valley, CA 92708-4092

Mailing address

12772 9TH St
Garden Grove, CA 92840-5406
Phone (714) 787-7567

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251216000440 CA Practitioner - Nurse Practitioner 1951895069 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alpha Hospitalist Group IncGroup PAC ID 7719266006, 14 clinicians

Practice addresses (Care Compare)

17100 Euclid St
Fountain Valley, CA 92708-4004
Phone (714) 966-7200

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95036371CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Alpha Hospitalist Group Inc CurrentSince Dec 1, 2025 Accepting new patients

Locations

17100 Euclid St
Fountain Vly, CA 92708
Phone (714) 966-7200

17150 Euclid St
Ste 200
Fountain Vly, CA 92708
Phone (714) 751-0995

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1755475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755475200000",
    "number": "1053298406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12772 9TH ST",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928405406",
            "telephone_number": "714-787-7567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17150 EUCLID ST STE 200",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927084092",
            "telephone_number": "714-395-4595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAM",
        "first_name": "JONATHAN",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-08-18",
        "last_updated": "2025-08-18",
        "certification_date": "2025-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95036371",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fountain Valley, CA

Sources for this page

Verify at the official NPI Registry.