Active NPI
Emma Trung Tra Phan, PSY.D.
- Clinical Psychologist
- Chula Vista, CA
National Provider Identifier
1609104264
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY23223
- Practice address
- 821 Kuhn Dr
Suite 102
Chula Vista, CA 91914-4508 - Phone
- (619) 997-6268
- NPI assigned
- Nov 19, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY23223 | CA | Primary |
Addresses
Primary practice location
821 Kuhn Dr
Suite 102
Chula Vista, CA 91914-4508
Mailing address
821 Kuhn Dr
Suite 102
Chula Vista, CA 91914-4508
Phone (619) 997-6268
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY23223 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1258588800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1378339200000",
"number": "1609104264",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "821 KUHN DR",
"address_2": "SUITE 102",
"city": "CHULA VISTA",
"state": "CA",
"postal_code": "919144508",
"telephone_number": "619-997-6268"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "821 KUHN DR",
"address_2": "SUITE 102",
"city": "CHULA VISTA",
"state": "CA",
"postal_code": "919144508",
"telephone_number": "619-997-6268"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "EMMA",
"middle_name": "TRUNG TRA",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-11-19",
"last_updated": "2013-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY23223",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chula Vista, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.