Active NPI
Michelle Quynh Dao Phan, M.D.
- Pediatrics Physician
- Fairfax, VA
National Provider Identifier
1417311374
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 0101275186
- Practice address
- 13135 Route 50 Ste 201
Fairfax, VA 22033-1907 - Phone
- (703) 391-0900
- Fax
- (703) 391-2919
- NPI assigned
- Apr 7, 2016
- Last updated
- Aug 29, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | NU | ||
| Pediatrics Physician | 208000000X | MD468228 | PA | |
| Pediatrics Physician | 208000000X | A163063 | CA | |
| Pediatrics Physician | 208000000X | 35.136445 | OH | |
| Pediatrics Physician | 208000000X | 036.150664 | IL | |
| Pediatrics Physician | 208000000X | 0101275186 | VA | Primary |
Addresses
Primary practice location
13135 Route 50 Ste 201
Fairfax, VA 22033-1907
Mailing address
13135 Route 50 Ste 201
Fairfax, VA 22033-1907
Phone (703) 391-0900
Other practice location 1
845 W Wilson Ave
Chicago, IL 60640-8090
Phone (773) 506-4283
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A163063 | CA | MD | Pediatrics Physician |
| 036.150664 | IL | MD | Pediatrics Physician |
| 35.136445 | OH | MD | Pediatrics Physician |
| MD468228 | PA | MD | Pediatrics Physician |
| 0101275186 | VA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Trusted Doctors LLC | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- michelle.phan@ffxpeds.eclinicaldirectplus.com
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Pediatrics Physician
- Fairfax, VA
- NPI 1083793525
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1459987200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1756425600000",
"number": "1417311374",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13135 ROUTE 50 STE 201",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220331907",
"telephone_number": "703-391-0900",
"fax_number": "703-391-2919"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13135 ROUTE 50 STE 201",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220331907",
"telephone_number": "703-391-0900",
"fax_number": "703-391-2919"
}
],
"practiceLocations": [
{
"address_1": "845 W Wilson Ave",
"address_purpose": "LOCATION",
"city": "Chicago",
"state": "IL",
"postal_code": "606408090",
"country_code": "US",
"telephone_number": "773-506-4283",
"fax_number": "773-506-4847",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PHAN",
"first_name": "MICHELLE",
"middle_name": "QUYNH DAO",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-04-07",
"last_updated": "2025-08-29",
"certification_date": "2025-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "PA",
"license": "MD468228",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A163063",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OH",
"license": "35.136445",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": "036.150664",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "VA",
"license": "0101275186",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Fairfax, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 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.