Active NPI
Khoi Van Phan, PHARM.D
- Pharmacist
- Dallas, TX
National Provider Identifier
1083963680
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 52113
- Practice address
- 11700 Preston Rd
Ste 703
Dallas, TX 75230-6112 - Phone
- (214) 750-4502
- Fax
- (214) 750-4951
- NPI assigned
- Aug 29, 2012
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 52113 | TX | Primary |
Addresses
Primary practice location
11700 Preston Rd
Ste 703
Dallas, TX 75230-6112
Mailing address
1836 W Davis St
Apt 1224
Dallas, TX 75208-5411
Phone (405) 590-9375
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
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.
-
- Pharmacy
- Dallas, TX
- NPI 1154604130
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- Longview, TX
- NPI 1629956545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346198400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1369353600000",
"number": "1083963680",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1836 W DAVIS ST",
"address_2": "APT 1224",
"city": "DALLAS",
"state": "TX",
"postal_code": "752085411",
"telephone_number": "405-590-9375"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11700 PRESTON RD",
"address_2": "STE 703",
"city": "DALLAS",
"state": "TX",
"postal_code": "752306112",
"telephone_number": "214-750-4502",
"fax_number": "214-750-4951"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "KHOI",
"middle_name": "VAN",
"name_prefix": "Dr.",
"credential": "PHARM.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-08-29",
"last_updated": "2013-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "52113",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.