Mai Tuyet Phan Medical Clinic a Professional Corporation

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

License

A51466 Issued in CA

Legal business name

MAI TUYET PHAN MEDICAL CLINIC A PROFESSIONAL CORPORATION

Practice address

18625 Sherman Way
Suite 104
Reseda, CA 91335-4148

Phone

(818) 342-8171

NPI assigned

Jan 13, 2011

Organization subpart

No

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

Authorized official

Name

Mai Tuyet Phan, M.D.NPI 1306879283

Title

M.D.

Phone

(818) 342-8171

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mai Tuyet Phan, M.D.

  • Internal Medicine Physician
  • Reseda, CA
  • NPI 1306879283
  Medicare reassignment Care Compare group Authorized official
• Agnes Bahng, MD

  • Internal Medicine Physician
  • Reseda, CA
  • NPI 1740570100
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1294876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317945600000",
    "number": "1588969026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18625 SHERMAN WAY",
            "address_2": "SUITE 104",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913354148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18625 SHERMAN WAY",
            "address_2": "SUITE 104",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913354148",
            "telephone_number": "818-342-8171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAI TUYET PHAN MEDICAL CLINIC A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-13",
        "last_updated": "2011-10-07",
        "status": "A",
        "authorized_official_last_name": "PHAN",
        "authorized_official_first_name": "MAI",
        "authorized_official_middle_name": "TUYET",
        "authorized_official_title_or_position": "M.D.",
        "authorized_official_telephone_number": "818-342-8171",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "CA",
            "license": "A51466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Macias Almazan, DDS
• Erica Macias
• Michelle Ann Maggiano
• Magnolia Medical Services
• Hollie Maguire
• Malek and Chahayed Healthline Chiropractic Corp.
• Leila Malekpour
• Malintze Gutierrez,D.O. Inc (Orion Health)
• Malintze Gutierrez,D.O.,Inc. (Orion Health)
• Harold Manansala

• Health Service Clinic/Center in Reseda, CA
• Providers in Reseda, CA by specialty
• Health Service Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.