Active NPI
Tuan Phan
- Community Health Worker
- Malden, MA
National Provider Identifier
1336659689
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- Practice address
- 22 Pleasant St
Malden, MA 02148-5119 - Phone
- (781) 851-2648
- NPI assigned
- Oct 1, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Behavior Technician | 106S00000X | |||
| Community Health Worker | 172V00000X | Primary |
Addresses
Primary practice location
22 Pleasant St
Malden, MA 02148-5119
Mailing address
11 Estes St
Lynn, MA 01902-3057
Phone (857) 222-1710
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| N0114518701 | Other | MA | TUFTS HEALTH PLAN |
| 100042212066 | Other | MA | MASSHEALTH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1506816000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1506816000000",
"number": "1336659689",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 ESTES ST",
"city": "LYNN",
"state": "MA",
"postal_code": "019023057",
"telephone_number": "857-222-1710"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22 PLEASANT ST",
"city": "MALDEN",
"state": "MA",
"postal_code": "021485119",
"telephone_number": "781-851-2648"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "TUAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-10-01",
"last_updated": "2017-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
},
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS HEALTH PLAN",
"identifier": "N0114518701",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MASSHEALTH",
"identifier": "100042212066",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Malden, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.