Individual provider Active NPI

James Van Phan, MD

  • Pediatrics Physician
  • Yorba Linda, CA
National Provider Identifier
1407482490
Registry record updated Jul 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A186177 Issued in CA
Practice address
4300 Rose Dr
Yorba Linda, CA 92886-2026
Phone
(714) 528-4211
Fax
(714) 528-3041
NPI assigned
Mar 21, 2020
Last updated
Jul 21, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X PTL3011 CA
Pediatrics Physician 208000000X A186177 CA Primary

Addresses

Primary practice location

4300 Rose Dr
Yorba Linda, CA 92886-2026

Mailing address

4300 Rose Dr
Yorba Linda, CA 92886-2026
Phone (714) 528-4211

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230803003473 CA Practitioner - Pediatric Medicine 2264835651 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A186177CAMDPediatrics Physician
PTL3011CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation Current Accepting new patients
Providence Medical Foundation CurrentSince Jul 10, 2023 Accepting new patients
Providence Medical Foundation CurrentSince Jul 10, 2023 Accepting new patients
St Jude Hospital Inc Past Accepting new patients
Providence Medical Foundation Past Accepting new patients

Locations

200 W Ctr St Promenade
Ste 300
Anaheim, CA 92805
Phone (714) 449-4841

100 E Valencia Mesa Dr
Ste 105
Fullerton, CA 92835
Phone (714) 446-5200

1950 Sunny Crest Dr
Ste 2900
Fullerton, CA 92835

4300 Rose Dr
Yorba Linda, CA 92886
Phone (714) 528-4211

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1584748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689897600000",
    "number": "1407482490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 ROSE DR",
            "city": "YORBA LINDA",
            "state": "CA",
            "postal_code": "928862026",
            "telephone_number": "714-528-4211",
            "fax_number": "714-528-3041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 ROSE DR",
            "city": "YORBA LINDA",
            "state": "CA",
            "postal_code": "928862026",
            "telephone_number": "714-528-4211",
            "fax_number": "714-528-3041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "JAMES",
        "middle_name": "VAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-21",
        "last_updated": "2023-07-21",
        "certification_date": "2023-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "PTL3011",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A186177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yorba Linda, CA

Sources for this page

Verify at the official NPI Registry.