Individual provider Active NPI

Khanh Phung

  • Internal Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1053704593
Registry record updated Dec 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
OS024157 Issued in PA
Practice address
1407 Rhawn St
Philadelphia, PA 19111-2803
Phone
(267) 957-7027
NPI assigned
Mar 9, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 6, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X OS024157 PA Primary

Addresses

Primary practice location

1407 Rhawn St
Philadelphia, PA 19111-2803

Mailing address

41 University Dr Ste 300
Newtown, PA 18940-1873

Other practice location 1

2601 Holme Ave
Philadelphia, PA 19152-2007
Phone (267) 957-7027

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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

Enrollment IDStateProvider typePAC IDDetails
I20241101001809 PA Practitioner - Internal Medicine 8426393026 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
West Virginia School of Osteopathic Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Trinity Health Mid-Atlantic Medical GroupGroup PAC ID 7416861885, 350 clinicians

Practice addresses (Care Compare)

1201 Langhorne Newtown Rd
Langhorne, PA 19047-1201

2601 Holme Ave
Philadelphia, PA 19152-2007
Phone (267) 957-7027

Hospital & facility affiliations

  • Mercy Home Health Home health agency, Newtown, PA, CCN 397015
  • Nazareth Hospital Hospital, Philadelphia, PA, CCN 390204

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Trinity Health Mid-Atlantic Medical Group CurrentSince Nov 1, 2024 Accepting new patients
Trinity Health Mid-Atlantic Medical Group Current Accepting new patients
Trinity Health Mid-Atlantic Medical Group CurrentSince Nov 1, 2024 Accepting new patients
Trinity Health Mid-Atlantic Medical Group Past Accepting new patients

Locations

41 University Dr
Ste 300
Newtown, PA 18940
Phone (215) 710-7037

1201 Langhorne Newtown Rd
Penndel, PA 19047
Phone (215) 710-2100

2601 Holme Ave
Philadelphia, PA 19152
Phone (215) 335-6000

1407 Rhawn St
Philadelphia, PA 19111
Phone (215) 725-3619

Interoperability endpoints

  • Direct secure messaging: kphung3866332@direct.trinity-health.org

Organizations & group practices 4

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

Hospital & facility affiliations 1

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": "1425859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733443200000",
    "number": "1053704593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 UNIVERSITY DR STE 300",
            "city": "NEWTOWN",
            "state": "PA",
            "postal_code": "189401873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1407 RHAWN ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191112803",
            "telephone_number": "267-957-7027"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2601 Holme Ave",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191522007",
            "country_code": "US",
            "telephone_number": "267-957-7027",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHUNG",
        "first_name": "KHANH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-03-09",
        "last_updated": "2024-12-06",
        "certification_date": "2024-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "OS024157",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.