Individual provider Active NPI

Phuong Thi Kim Tran, PA-C

  • Medical Physician Assistant
  • San Diego, CA
National Provider Identifier
1063532232
Registry record updated Oct 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA 18370 Issued in CA
Practice address
6195 Lusk Blvd Ste 250
San Diego, CA 92121-3715
Phone
(858) 859-1188
NPI assigned
Mar 30, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA 18370 CA Primary

Addresses

Primary practice location

6195 Lusk Blvd Ste 250
San Diego, CA 92121-3715

Mailing address

10444 Flanders CV
San Diego, CA 92126-3031

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
I20111101000267 CA Practitioner - Physician Assistant 4981877321 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
18370CAMDAcupuncturist
PA 18370CAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Haramandeep Singh MD Inc CurrentSince Jan 2, 2026 Accepting new patients
Bass Medical Group Past Accepting new patients

Locations

2500 Old Crow Canyon Rd
Ste 505
San Ramon, CA 94583
Phone (925) 415-5353

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/2732/brand/1/csg/1/fhir/r4

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666828800000",
    "number": "1063532232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10444 FLANDERS CV",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921263031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6195 LUSK BLVD STE 250",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921213715",
            "telephone_number": "858-859-1188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAN",
        "first_name": "PHUONG",
        "middle_name": "THI KIM",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-30",
        "last_updated": "2022-10-27",
        "certification_date": "2022-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA 18370",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.