Kenny H Phan, CRT

Primary specialty

Magnetic Resonance Imaging Radiologic TechnologistTaxonomy code 2471M1202X

License

2719 Issued in FL

Practice address

13071 Brookhurst St Ste 100
Garden Grove, CA 92843-5514

Phone

(714) 425-9066

NPI assigned

Apr 20, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Excel Imaging Center Inc

  • Body Imaging Physician
  • Garden Grove, CA
  • NPI 1962910513
  NPD

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

{
    "created_epoch": "1618876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618876800000",
    "number": "1174104186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13071 BROOKHURST ST STE 100",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928435514",
            "telephone_number": "714-425-9066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13071 BROOKHURST ST STE 100",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928435514",
            "telephone_number": "714-425-9066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "KENNY",
        "middle_name": "H",
        "credential": "CRT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-04-20",
        "last_updated": "2021-04-20",
        "certification_date": "2021-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2471M1202X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist, Magnetic Resonance Imaging",
            "state": "FL",
            "license": "2719",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anh Minh Phan
• Chau Ngoc Thanh Phan, PHARM.D
• CHI Hong Phan
• Fyona Quynh Mi Phan
• Kathy Dongthi Phan
• Kevin Phan
• Khanh Phan, MA
• Kim Nguyen Phan, PH.D.
• Kimmy Phan
• Lynda Phan

• Magnetic Resonance Imaging Radiologic Technologist in Garden Grove, CA
• Providers in Garden Grove, CA by specialty
• Magnetic Resonance Imaging Radiologic Technologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.