Active NPI
Kelly Nguyen Phan, DPT
- Pediatric Physical Therapist
- Fullerton, CA
National Provider Identifier
1134553381
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 37683
- Practice address
- 233 Orangefair Mall
Fullerton, CA 92832-3038 - Phone
- (714) 870-6116
- Fax
- (714) 870-9038
- NPI assigned
- Aug 23, 2013
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 37683 | CA | Primary |
Addresses
Primary practice location
233 Orangefair Mall
Fullerton, CA 92832-3038
Mailing address
233 Orangefair Mall
Fullerton, CA 92832-3038
Phone (714) 870-6116
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250120000071 | CA | Practitioner - Physical Therapist in Private Practice | 8224567383 | Practice locations: Buena Park, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37683 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Therapy for Kids, Inc. | Pediatrics | Past | Accepting new patients |
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1377216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377216000000",
"number": "1134553381",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "233 ORANGEFAIR MALL",
"city": "FULLERTON",
"state": "CA",
"postal_code": "928323038",
"telephone_number": "714-870-6116",
"fax_number": "714-870-9038"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "233 ORANGEFAIR MALL",
"city": "FULLERTON",
"state": "CA",
"postal_code": "928323038",
"telephone_number": "714-870-6116",
"fax_number": "714-870-9038"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "KELLY",
"middle_name": "NGUYEN",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-08-23",
"last_updated": "2013-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "CA",
"license": "37683",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fullerton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.