Kevin Gia-Minh Phan, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

4708 Issued in OR

Practice address

12000 SE 82ND Ave Ste 2193
Happy Valley, OR 97086-7746

Phone

(503) 654-6217

Fax

(503) 654-9335

NPI assigned

Oct 24, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WA, OR2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Pacific Eye Group, PC

  • Optometrist
  • Bend, OR
  • NPI 1831656925

  WA

  Medicare reassignment NPD
• Charles Sung MD PC

  • Ophthalmology Physician
  • Kennewick, WA
  • NPI 1245358050
  Medicare reassignment NPD

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

{
    "created_epoch": "1571875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694476800000",
    "number": "1164065959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11084 SE 64TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972222319",
            "telephone_number": "503-890-7209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12000 SE 82ND AVE STE 2193",
            "city": "HAPPY VALLEY",
            "state": "OR",
            "postal_code": "970867746",
            "telephone_number": "503-654-6217",
            "fax_number": "503-654-9335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "KEVIN",
        "middle_name": "GIA-MINH",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-10-24",
        "last_updated": "2023-09-12",
        "certification_date": "2023-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "60964432",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "4708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peaceful Care House
• Peacehealth Networks on Demand, LLC
• Anna Christine Peaslee
• Adam Peterson, QMHP
• Heather Peterson
• Graham A Phelps, FNP-BC
• Crissy K Phommachack
• Physical Therapy Specialists
• Physiotherapy Associates Inc.
• Lizette C Picasso, MSNE, MSED

• Optometrist in Happy Valley, OR
• Providers in Happy Valley, OR by specialty
• Optometrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.