Vivien Phung, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

4301504829 Issued in MI

Practice address

205 N East Ave
Jackson, MI 49201-1753

Phone

(517) 205-4800

NPI assigned

Mar 22, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: vphung742035@direct.hfhs.org

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

• W. a. Foote Memorial Hospital, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Jackson, MI
  • NPI 1326078866
  Medicare reassignment NPD
• W.a. Foote Memorial Hospital, Inc

  • Physician Assistant
  • Jackson, MI
  • NPI 1538606348
  NPD
• W.a. Foote Memorial Hospital, Inc

  • Pediatrics Physician
  • Jackson, MI
  • NPI 1891232740
  NPD
• Pediatric Subspecialty Faculty, Inc.

  • Pediatrics Physician
  • Orange, CA
  • NPI 1790850279
  NPD (past)
• University of California Irvine

  • General Acute Care Hospital
  • Orange, CA
  • NPI 1689608150
  NPD (past)

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

{
    "created_epoch": "1521676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624492800000",
    "number": "1447754437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 FORD PL STE 2E",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482023450",
            "telephone_number": "313-874-4806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 N EAST AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011753",
            "telephone_number": "517-205-4800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "505 S Main St Ste 525",
            "address_purpose": "LOCATION",
            "city": "Orange",
            "state": "CA",
            "postal_code": "928684553",
            "country_code": "US",
            "telephone_number": "714-456-5631",
            "fax_number": "714-285-0389",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHUNG",
        "first_name": "VIVIEN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-22",
        "last_updated": "2021-06-24",
        "certification_date": "2021-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "164816",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301504829",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pharaoh'S Rest Haven, L.L.C
• Ashley Phelps, LPC
• Brittany Latrice Phillips
• Drew Phillips
• PHS of Michigan PC
• Raven Picciotti
• Bruce Pickell
• Taryn Sue Pickell
• Daniel Karl Piekarek, NPC
• Elizabeth J Pielsticker, MD

• Pediatrics Physician in Jackson, MI
• Providers in Jackson, MI by specialty
• Pediatrics Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.