Aivi Dolan Phung, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA53902 Issued in CA

Practice address

6973 Linda Vista Rd
San Diego, CA 92111-6342

Phone

(858) 279-0925

NPI assigned

Jun 6, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Loma Linda University School of Medicine, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Southern California Permanente Medical GroupGroup PAC ID 6002729175, 11,250 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: aivi.phung@3856.securemail.prognocis.com

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.

• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Baldwin Park, CA
  • NPI 1770515280
  Medicare reassignment Care Compare group
• American Current Care of California, a Medical Corporation

  • Clinic/Center
  • Los Angeles, CA
  • NPI 1750573622
  Medicare reassignment
• American Current Care of California, a Medical Corporation

  • Urgent Care Clinic/Center
  • Chatsworth, CA
  • NPI 1396211801
  NPD
• American Current Care of California, a Medical Corporation

  • Urgent Care Clinic/Center
  • Ontario, CA
  • NPI 1811464084
  NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • San Diego, CA
  • NPI 1225060742
  NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Santa Clarita, CA
  • NPI 1316409410
  NPD

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

{
    "created_epoch": "1465171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703203200000",
    "number": "1639528110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6973 LINDA VISTA RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921116342",
            "telephone_number": "858-279-0925",
            "fax_number": "858-633-4680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6973 LINDA VISTA RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921116342",
            "telephone_number": "858-279-0925"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5575 Ruffin Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921231361",
            "country_code": "US",
            "telephone_number": "858-277-2744",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHUNG",
        "first_name": "AIVI",
        "middle_name": "DOLAN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-06-06",
        "last_updated": "2023-12-22",
        "certification_date": "2020-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA53902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4760 W Sunset Blvd",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900276063",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• PHP Ins Ca PC
• Nicholas John Phreaner, M.D.
• Wilson Phu, OD
• Huy Q Phun, MD
• Nancy Phung-Smith, LMFT138181
• Brian Phung
• Karen Huynh Phung
• Richard N.V. Phung, O.D.
• Trinh Van Anh Phung
• Phuranda Inc.

• Physician Assistant in San Diego, CA
• Providers in San Diego, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2023; 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.
• 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.