Mary Nhung Hoai Phan

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

9120846 Issued in FL

Practice address

17100 Norwalk Blvd Ste 101
Cerritos, CA 90703-2750

Phone

(562) 232-9420

NPI assigned

Oct 9, 2025

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1759968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765152000000",
    "number": "1396610341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9801 BELVEDERE RD",
            "city": "ROYAL PALM BEACH",
            "state": "FL",
            "postal_code": "334113640",
            "telephone_number": "561-273-6500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17100 NORWALK BLVD STE 101",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907032750",
            "telephone_number": "562-232-9420"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9801 Belvedere Rd",
            "address_purpose": "LOCATION",
            "city": "Royal Palm Beach",
            "state": "FL",
            "postal_code": "334113640",
            "country_code": "US",
            "telephone_number": "561-273-6500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHAN",
        "first_name": "MARY",
        "middle_name": "NHUNG HOAI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-10-09",
        "last_updated": "2025-12-08",
        "certification_date": "2025-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "9120846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Haley Petruccelli
• Jathaniel A Pettitt, LPCC
• Shawn Wright Pfendler, MHA
• Diep Ngoc Thi Pham
• Quy Pham, PMHNP
• Athena Phang
• Wan Yi Phang
• Pharmaceutical Delivery, Inc.
• Philip I Kress DMD a Professional Corporation
• Phoenix Optometry Group Inc

• Physician Assistant in Cerritos, CA
• Providers in Cerritos, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.