Individual provider Active NPI

Phuong T Tran, DNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Irvine, CA
National Provider Identifier
1275990111
Registry record updated Jul 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95003693 Issued in CA
Practice address
17782 Cowan Ste a
Irvine, CA 92614
Phone
(949) 722-7118
Fax
(949) 579-9102
NPI assigned
Jan 22, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95003693 CA Primary

Addresses

Primary practice location

17782 Cowan Ste a
Irvine, CA 92614

Mailing address

17782 Cowan Ste a
Irvine, CA 92614-6041
Phone (949) 722-7118

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20160314000930 CA Practitioner - Nurse Practitioner 4981900297 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Jason Kellogg MD IncGroup PAC ID 9032266127, 19 clinicians
Progeny Psychiatric Clinic a Medical CorporationGroup PAC ID 4688904592, 33 clinicians

Practice addresses (Care Compare)

1715 S Cedar Ave
Asfc LLC
Fresno, CA 93702-4331
Phone (559) 237-8377

17782 Cowan
Suite a
Irvine, CA 92614-6041
Phone (949) 722-7118

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
95003693CAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Jason Kellogg M.D. Inc CurrentSince Feb 8, 2016 Accepting new patients
Progeny TMS Corporation CurrentSince Jun 16, 2024 Accepting new patients

Locations

1715 S Cedar Ave
Fresno, CA 93702
Phone (559) 237-8377

17782 Cowan
Ste D
Irvine, CA 92614
Phone (949) 748-1531

17782 Cowan
Ste A
Irvine, CA 92614

1501 E 16th St
Newport Beach, CA 92663
Phone (714) 366-6371

1048 Irvine Ave
Newport Beach, CA 92660
Phone (949) 340-2111

14501 Magnolia St
Ste 104
Westminster, CA 92683
Phone (714) 891-0080

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1453420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531008000000",
    "number": "1275990111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17782 COWAN STE A",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926146041",
            "telephone_number": "949-722-7118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17782 COWAN STE A",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "92614",
            "telephone_number": "949-722-7118",
            "fax_number": "949-579-9102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAN",
        "first_name": "PHUONG",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "DNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-01-22",
        "last_updated": "2018-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95003693",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Irvine, CA

Sources for this page

Verify at the official NPI Registry.