Individual provider Active NPI

Mayngan P Stone, PA-C

  • Physician Assistant
  • Covina, CA
National Provider Identifier
1629097100
Registry record updated Jan 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA17571 Issued in CA
Practice address
420 W Rowland St
Covina, CA 91723-2943
Phone
(626) 331-6411
Fax
(626) 251-1560
NPI assigned
Jul 18, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA17571 CA Primary

Addresses

Primary practice location

420 W Rowland St
Covina, CA 91723-2943

Mailing address

420 W Rowland St
Covina, CA 91723-2943
Phone (626) 331-6411

Other names 1

  • Ms. Mayngan H Phan Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA17571CAMDPhysician Assistant
17571CAMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeside Medical Associates, a Medical Group, Inc. Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: mayngan.stone.p1@direct.lakeside.nextgenshare.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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420761600000",
    "number": "1629097100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 W ROWLAND ST",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917232943",
            "telephone_number": "626-331-6411",
            "fax_number": "626-251-1560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 W ROWLAND ST",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917232943",
            "telephone_number": "626-331-6411",
            "fax_number": "626-251-1560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STONE",
        "first_name": "MAYNGAN",
        "middle_name": "P",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-18",
        "last_updated": "2015-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA17571",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MAYNGAN",
            "last_name": "PHAN",
            "middle_name": "H",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Covina, CA

Sources for this page

Verify at the official NPI Registry.