Active NPI
Yvonne Phan
- Pharmacist
- Lodi, CA
National Provider Identifier
1396276705
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 45939
- Practice address
- 2680 Reynolds Ranch Pkwy
Lodi, CA 95240-6848 - Phone
- (209) 366-7301
- NPI assigned
- Mar 27, 2017
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 45939 | CA | Primary |
Addresses
Primary practice location
2680 Reynolds Ranch Pkwy
Lodi, CA 95240-6848
Mailing address
8635 Kingslynn CT
Elk Grove, CA 95624-3135
Phone (916) 531-5430
Other names 1
- Yvonne Yxuan P Phan
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 45939 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490572800000",
"number": "1396276705",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8635 KINGSLYNN CT",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "956243135",
"telephone_number": "916-531-5430"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2680 REYNOLDS RANCH PKWY",
"city": "LODI",
"state": "CA",
"postal_code": "952406848",
"telephone_number": "209-366-7301"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "YVONNE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-03-27",
"last_updated": "2017-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "45939",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "YVONNE YXUAN",
"last_name": "PHAN",
"middle_name": "P",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Lodi, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 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.