Derek Truong Phan MD Inc

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A99908 Issued in CA

Legal business name

DEREK TRUONG PHAN MD INC

Practice address

9191 Bolsa Ave
Suite 205
Westminster, CA 92683-5564

Phone

(714) 891-7035

Fax

(714) 897-8304

NPI assigned

Oct 21, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Derek Phan, MDNPI 1073729588

Title

Owner

Phone

(714) 383-1661

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Derek T Phan, M.D.

  • Internal Medicine Physician
  • Westminster, CA
  • NPI 1073729588
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1256083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256083200000",
    "number": "1598091837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9191 BOLSA AVE",
            "address_2": "SUITE 205",
            "city": "WESTMINSTER",
            "state": "CA",
            "postal_code": "926835564",
            "telephone_number": "714-891-7035",
            "fax_number": "714-897-8304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9191 BOLSA AVE",
            "address_2": "SUITE 205",
            "city": "WESTMINSTER",
            "state": "CA",
            "postal_code": "926835564",
            "telephone_number": "714-891-7035",
            "fax_number": "714-897-8304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEREK TRUONG PHAN MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-21",
        "last_updated": "2009-10-21",
        "status": "A",
        "authorized_official_last_name": "PHAN",
        "authorized_official_first_name": "DEREK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "714-383-1661",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A99908",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Westminster, CA
• Providers in Westminster, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.