Tai Thien Phung, PMHNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

NP95019571 Issued in CA

Practice address

9353 Valley Blvd
Rosemead, CA 91770-1923

Phone

(626) 287-2988

NPI assigned

Sep 21, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

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

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

M and H Provider Services LLCGroup PAC ID 2163955014, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• M & H Provider Services, LLC

  • Community/Behavioral Health Agency
  • Monterey Park, CA
  • NPI 1336974039
  Medicare reassignment Care Compare group NPD
• Pacific Clinics

  • Community/Behavioral Health Agency
  • Campbell, CA
  • NPI 1255496105
  Medicare reassignment NPD
• Pacific Clinics

  • Community/Behavioral Health Agency
  • Fresno, CA
  • NPI 1336458934
  NPD
• Pacific Clinics

  • Community/Behavioral Health Agency
  • Santa Fe Springs, CA
  • NPI 1588322044
  NPD

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

{
    "created_epoch": "1600646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647388800000",
    "number": "1760098032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9353 VALLEY BLVD",
            "city": "ROSEMEAD",
            "state": "CA",
            "postal_code": "917701923",
            "telephone_number": "626-287-2988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9353 VALLEY BLVD",
            "city": "ROSEMEAD",
            "state": "CA",
            "postal_code": "917701923",
            "telephone_number": "626-287-2988"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1020 S Arroyo Pkwy",
            "address_purpose": "LOCATION",
            "city": "Pasadena",
            "state": "CA",
            "postal_code": "911053911",
            "country_code": "US",
            "telephone_number": "626-403-2794",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHUNG",
        "first_name": "TAI",
        "middle_name": "THIEN",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-09-21",
        "last_updated": "2022-03-16",
        "certification_date": "2022-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "CA",
            "license": "780978",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "NP95019571",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Loan Phu, PHARMD
• Kenneth Phun, MD
• Kevin Phun, PA-C
• Ruby Phun
• CHI Nam Phung
• Pill Box Pharmacy, LLC
• Katya Shawday Pirir
• Scott Plant, L.AC
• PO Long Lew, D.O. a Medical Professional Corp.
• Jesusa Portillo, LVN

• Nurse Practitioner in Rosemead, CA
• Providers in Rosemead, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2022; 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.