Kimlong Nguyen Phan

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

66053 Issued in CA

Practice address

1798 N Garey Ave
Pomona, CA 91767-2918

Phone

(909) 865-9500

NPI assigned

Jan 7, 2025

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Cep America - California

  • Emergency Medicine Physician
  • Santa Ana, CA
  • NPI 1548667843
  Medicare reassignment
• Cep America - California

  • Emergency Medicine Physician
  • Pomona, CA
  • NPI 1740235258
  NPD

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

{
    "created_epoch": "1736208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740787200000",
    "number": "1780494344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1086 S THOMAS ST",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917663236",
            "telephone_number": "909-524-6996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1798 N GAREY AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917672918",
            "telephone_number": "909-865-9500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "KIMLONG",
        "middle_name": "NGUYEN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-01-07",
        "last_updated": "2025-03-01",
        "certification_date": "2025-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "66053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anh Phan
• Christopher Phan
• Dean Phan, DO
• Jodie Phan
• Kenny Phan
• Nghia Thanh Phan, D.O.
• Preeti Phan
• Sarah T. Phan
• Vivian Diep Phan
• Jennifer Bopha Phang

• Physician Assistant in Pomona, CA
• Providers in Pomona, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.