Cong T. Phan M.D., Inc.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

CONG T. PHAN M.D., INC.

Practice address

8235 Rochester Ave Ste 110
Rancho Cucamonga, CA 91730-0719

Phone

(909) 484-4900

Fax

(909) 781-2949

NPI assigned

Oct 2, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Cong T. Phan, M.D.NPI 1386778033

Title

President

Phone

(909) 941-4777

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Cong Thanh Phan, M.D.

  • Internal Medicine Physician
  • Rancho Cucamonga, CA
  • NPI 1386778033
  Medicare reassignment NPD Authorized official
• Amy DO, PA-C

  • Physician Assistant
  • Rancho Cucamonga, CA
  • NPI 1982128260
  Medicare reassignment
• Rene W Lee, D.O.

  • Pediatrics Physician
  • Rancho Cucamonga, CA
  • NPI 1467694000
  NPD (past)

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

{
    "created_epoch": "1380672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727222400000",
    "number": "1114354396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9303 JASMINE AVE",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927081960",
            "telephone_number": "909-941-4777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8235 ROCHESTER AVE STE 110",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917300719",
            "telephone_number": "909-484-4900",
            "fax_number": "909-781-2949"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4950 San Bernardino St Ste 107",
            "address_purpose": "LOCATION",
            "city": "Montclair",
            "state": "CA",
            "postal_code": "917632328",
            "country_code": "US",
            "telephone_number": "909-963-0800",
            "fax_number": "909-296-7999",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CONG T. PHAN M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-02",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-25",
        "status": "A",
        "authorized_official_last_name": "PHAN",
        "authorized_official_first_name": "CONG",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-941-4777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mikayla Connell
• Kendall Conner
• David Allan Connett, D.O.
• Kendall Laurice Connor, MS

• Internal Medicine Physician in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.

Verify at the official NPI Registry.