Jimmy Ninh Hoang Phan, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

141765 Issued in CA

Practice address

425 Diamond Dr Ste 103
Lake Elsinore, CA 92530-4495

Phone

(951) 981-3122

Fax

(951) 981-3123

NPI assigned

May 2, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Dr. Jimmy Phan Medical Corporation

  • Pediatrics Physician
  • Lake Elsinore, CA
  • NPI 1144989385
  NPD Authorized official
• Tarin Medical Corporation

  • Anesthesiology Physician
  • Corona, CA
  • NPI 1427169366

  Pediatrics

  NPD (past)
• Uhs Corona Inc

  • Rehabilitation Hospital Unit
  • Corona, CA
  • NPI 1255327920
  NPD (past)
• Universal Health Services of Rancho Springs Inc

  • General Acute Care Hospital
  • Murrieta, CA
  • NPI 1245221050
  NPD (past)

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

{
    "created_epoch": "1367452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643241600000",
    "number": "1770928962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 DIAMOND DR STE 103",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925304495",
            "telephone_number": "951-981-3122",
            "fax_number": "951-981-3123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 DIAMOND DR STE 103",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925304495",
            "telephone_number": "951-981-3122",
            "fax_number": "951-981-3123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "JIMMY",
        "middle_name": "NINH HOANG",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-05-02",
        "last_updated": "2022-01-27",
        "certification_date": "2022-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "141765",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brenda Perez
• Emily Crystal Perez
• Isis Charney Perez
• Kimberly A Perkins
• Andrew T Pham, D.C.
• Phillip Rechister
• Alyssa Phillipe, M.A., BCBA
• Mark G Phillipe, DDS
• Danial Ray Phipps Jr.
• Anh-Hoa Phung

• Pediatrics Physician in Lake Elsinore, CA
• Providers in Lake Elsinore, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.