Active NPI
Phyllis Wang Acon, M.D.
- Pediatrics Physician
- Danville, CA
National Provider Identifier
1306133319
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- A114283
- Practice address
- 210 Monte Carlo Way
Danville, CA 94506-4689 - Phone
- (925) 708-4454
- NPI assigned
- Jun 29, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A114283 | CA | Primary |
Addresses
Primary practice location
210 Monte Carlo Way
Danville, CA 94506-4689
Mailing address
210 Monte Carlo Way
Danville, CA 94506-4689
Phone (925) 708-4454
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: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151007003398 | CA | Practitioner - Pediatric Medicine | 7416265673 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 114283 | CA | MD | Marriage & Family Therapist |
| A114283 | CA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| LPCH Medical Group Div of Lucile | Pediatrics | Current | Accepting new patients |
Locations
725 Welch Rd
Palo Alto, CA 94304
Phone (650) 497-8979
Organizations & group practices 1
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": "1309305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1436832000000",
"number": "1306133319",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 MONTE CARLO WAY",
"city": "DANVILLE",
"state": "CA",
"postal_code": "945064689",
"telephone_number": "925-708-4454"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 MONTE CARLO WAY",
"city": "DANVILLE",
"state": "CA",
"postal_code": "945064689",
"telephone_number": "925-708-4454"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ACON",
"first_name": "PHYLLIS",
"middle_name": "WANG",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-06-29",
"last_updated": "2015-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A114283",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Danville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2015; 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.