Individual provider Active NPI

Hoa Quang Phan

  • Podiatrist
  • Hampton, VA
National Provider Identifier
1790359099
Registry record updated May 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
0103301477 Issued in VA
Practice address
2114 Harford Rd
Suite a
Hampton, VA 23666
Phone
(757) 224-7605
Fax
(757) 525-2854
NPI assigned
May 19, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 0103301477 VA Primary

Addresses

Primary practice location

2114 Harford Rd
Suite a
Hampton, VA 23666

Mailing address

1155 Professional Dr
Williamsburg, VA 23185-3329
Phone (757) 220-3311

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260227004126 VA Practitioner - Podiatry 7810399979 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Temple University School of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sara Bouraee LLCGroup PAC ID 7719056076, 5 clinicians

Practice addresses (Care Compare)

2114 Hartford Rd
Suite a
Hampton, VA 23666-2409
Phone (757) 224-7605

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0103301477VAMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Sara Bouraee, LLC CurrentSince Feb 1, 2026 Accepting new patients
Sara Bouraee, LLC Podiatrist CurrentSince Feb 1, 2026 Accepting new patients

Locations

2114 Hartford Rd
#A
Hampton, VA 23666
Phone (757) 220-3311

1155 Professional Dr
Williamsburg, VA 23185
Phone (757) 220-3311

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1621382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778630400000",
    "number": "1790359099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1155 PROFESSIONAL DR",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231853329",
            "telephone_number": "757-220-3311",
            "fax_number": "757-525-2854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2114 HARFORD RD",
            "address_2": "SUITE A",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "23666",
            "telephone_number": "757-224-7605",
            "fax_number": "757-525-2854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "HOA",
        "middle_name": "QUANG",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-19",
        "last_updated": "2026-05-13",
        "certification_date": "2026-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "VA",
            "license": "0103301477",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hampton, VA

Sources for this page

Verify at the official NPI Registry.