Kim Nguyen Phan, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY17605 Issued in CA

Practice address

12966 Euclid St
Suite 515
Garden Grove, CA 92840-5200

Phone

(714) 227-9770

NPI assigned

Oct 5, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

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

Enrolled in CA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Eugene Rosenman MD Professional Corporation

  • Adult Mental Health Clinic/Center
  • Anaheim, CA
  • NPI 1992588313
  Medicare reassignment NPD
• Inland Psychiatric Medical Group, Inc.

  • Psychiatry Physician
  • Redlands, CA
  • NPI 1649217761

  Clinical

  Medicare reassignment NPD
• Lindy Lay, D.O., P.C.

  • Community/Behavioral Health Agency
  • Costa Mesa, CA
  • NPI 1144909474
  Medicare reassignment NPD
• Inland Psychiatric Medical Group, Inc

  • Psychiatry Physician
  • Chino, CA
  • NPI 1770905663
  NPD
• Inland Psychiatric Medical Group, Inc.

  • Psychiatry Physician
  • Redlands, CA
  • NPI 1336977990
  NPD
• Inland Psychiatric Medical Group Inc

  • Psychiatry Physician
  • San Juan Capistrano, CA
  • NPI 1225786346
  NPD (past)

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1245327071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26345 YOLANDA ST",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926563114",
            "telephone_number": "949-831-1394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12966 EUCLID ST",
            "address_2": "SUITE 515",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928405200",
            "telephone_number": "714-227-9770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "KIM",
        "middle_name": "NGUYEN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY17605",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fyona Quynh Mi Phan
• Kathy Dongthi Phan
• Kenny H Phan, CRT
• Kevin Phan
• Khanh Phan, MA
• Kimmy Phan
• Leanne Phan, PA-C
• Lynda Phan
• Mikey Phan
• Mindy Trieu Phan, D.M.D

• Clinical Psychologist in Garden Grove, CA
• Providers in Garden Grove, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.