Individual provider Active NPI

Lee Thi Phan, PA

  • Surgical Physician Assistant
  • Henderson, NV
National Provider Identifier
1790458552
Registry record updated Mar 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA2950 Issued in NV
Practice address
2839 Saint Rose Pkwy Ste 100
Henderson, NV 89052-4849
Phone
(028) 378-9887
Fax
(702) 837-8988
NPI assigned
Jul 28, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA2950 NV Primary

Addresses

Primary practice location

2839 Saint Rose Pkwy Ste 100
Henderson, NV 89052-4849

Mailing address

2839 Saint Rose Pkwy Ste 100
Henderson, NV 89052-4849
Phone (702) 837-8988

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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

Enrollment IDStateProvider typePAC IDDetails
I20241003000765 NV Practitioner - Physician Assistant 4789081233 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA2950NVMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Curt Samlaska LTD Academic Dermatology of Nevada Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: lphan1456937@ehrdirect.mayoclinicmsg.org
  • Direct secure messaging: lphan@academic.encitedirect.com

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1627430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774310400000",
    "number": "1790458552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2839 SAINT ROSE PKWY STE 100",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890524849",
            "telephone_number": "702-837-8988",
            "fax_number": "702-990-5269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2839 SAINT ROSE PKWY STE 100",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890524849",
            "telephone_number": "028-378-9887",
            "fax_number": "702-837-8988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "LEE",
        "middle_name": "THI",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-28",
        "last_updated": "2026-03-24",
        "certification_date": "2026-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NV",
            "license": "PA2950",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NV

Sources for this page

Verify at the official NPI Registry.