Anh Phan

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

60377 Issued in CA

Practice address

1196 N Park Ave
Pomona, CA 91768-3027

Phone

(909) 623-4050

NPI assigned

Jul 13, 2020

Sex

Female

Sole proprietor

No

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: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Ajay G. Meka M.D. Inc.

  • Internal Medicine Physician
  • Santa Ana, CA
  • NPI 1932214657
  Medicare reassignment
• Amistad Multi Specialty Medical Group Inc.

  • Cardiovascular Disease Physician
  • Santa Ana, CA
  • NPI 1912556721
  NPD (past)
• Omni Family Health

  • Federally Qualified Health Center (FQHC)
  • Tehachapi, CA
  • NPI 1851325021
  NPD (past)

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

{
    "created_epoch": "1594598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640822400000",
    "number": "1265050546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4737 BANDERA ST",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "917634392",
            "telephone_number": "909-667-6608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1196 N PARK AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917683027",
            "telephone_number": "909-623-4050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "ANH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-13",
        "last_updated": "2021-12-30",
        "certification_date": "2021-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "60377",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kim Pham
• Lynn Pham, PA-C
• Maggie Pham, D.O.
• Quynh N Pham, OD
• Thuan G Pham, MD
• Christopher Phan
• Dean Phan, DO
• Jodie Phan
• Kenny Phan
• Kimlong Nguyen Phan

• Physician Assistant in Pomona, CA
• Providers in Pomona, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2021; 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.