Active NPI
Hieu Ngoc Phan, PHARMD
- Pharmacist
- Los Angeles, CA
National Provider Identifier
1679088470
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH80676
- Practice address
- 5601 Wilshire Blvd
Los Angeles, CA 90036-3701 - Phone
- (323) 936-0050
- NPI assigned
- Dec 4, 2017
- Last updated
- Oct 28, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH028039 | GA | |
| Pharmacist | 183500000X | RPH80676 | CA | Primary |
Addresses
Primary practice location
5601 Wilshire Blvd
Los Angeles, CA 90036-3701
Mailing address
5601 Wilshire Blvd
Los Angeles, CA 90036-3701
Phone (323) 936-0050
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)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH80676 | CA | MD | Pharmacist |
| RPH028039 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ralphs Grocery Company | Past | Accepting new patients | |
| Ralphs Grocery Company | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1512345600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603843200000",
"number": "1679088470",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5601 WILSHIRE BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900363701",
"telephone_number": "323-936-0050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5601 WILSHIRE BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900363701",
"telephone_number": "323-936-0050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "HIEU",
"middle_name": "NGOC",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-12-04",
"last_updated": "2020-10-28",
"certification_date": "2020-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH028039",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "RPH80676",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.