T Mai Phan MD Inc

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

T MAI PHAN MD INC

Practice address

9500 Bolsa Ave
Suite P
Westminster, CA 92683-5943

Phone

(714) 775-4400

Fax

(714) 775-0149

NPI assigned

Nov 18, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Tuyet-Mai Phan, M.D.NPI 1710900477

Title

President

Phone

(714) 775-4400

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tuyet-Mai M. Phan, M.D.

  • Ophthalmology Physician
  • Westminster, CA
  • NPI 1710900477
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1290038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1290038400000",
    "number": "1275835688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9500 BOLSA AVE",
            "address_2": "SUITE P",
            "city": "WESTMINSTER",
            "state": "CA",
            "postal_code": "926835943",
            "telephone_number": "714-775-4400",
            "fax_number": "714-775-0149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 BOLSA AVE",
            "address_2": "SUITE P",
            "city": "WESTMINSTER",
            "state": "CA",
            "postal_code": "926835943",
            "telephone_number": "714-775-4400",
            "fax_number": "714-775-0149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "T MAI PHAN MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-18",
        "last_updated": "2010-11-18",
        "status": "A",
        "authorized_official_last_name": "PHAN",
        "authorized_official_first_name": "TUYET-MAI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-775-4400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G576702",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G576701",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Supportive Care Services
• Supportive Care Services Foundation
• Angela Sureen, M.D.
• Joshua Stefan Suri, LPCC
• Greg Suzuki
• T&T Ultrasound Imaging Services
• Chuong Hoang Ta, DAOM, L.AC,
• Amber Marie Talbot, MPT
• Tam Ngo DDS, Inc.
• Whitney Tam

• Clinic/Center in Westminster, CA
• Providers in Westminster, CA by specialty
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2010; 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.

Verify at the official NPI Registry.