Individual provider Active NPI

Michelle Quynh Dao Phan, M.D.

  • Pediatrics Physician
  • Fairfax, VA
National Provider Identifier
1417311374
Registry record updated Aug 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
0101275186 Issued in VA
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, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2025

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
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

LicenseStateTypeSpecialty
A163063CAMDPediatrics Physician
036.150664ILMDPediatrics Physician
35.136445OHMDPediatrics Physician
MD468228PAMDPediatrics Physician
0101275186VAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Trusted Doctors LLC Pediatrics PastSince Sep 3, 2025 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: 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.

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.

Verify at the official NPI Registry.