Derek Q Phan MD Medical Corporation

Primary specialty

Interventional Cardiology PhysicianTaxonomy code 207RI0011X

Legal business name

DEREK Q PHAN MD MEDICAL CORPORATION

Practice address

800 S Main St
Corona, CA 92882-3420

Phone

(213) 569-1450

NPI assigned

Jun 9, 2023

Organization subpart

No

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

Authorized official

Name

Derek Q Phan, MD

Title

President

Phone

(951) 324-3157

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1686268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686268800000",
    "number": "1851075907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10798 JURUPA RD",
            "address_2": "PO BOX 136",
            "city": "JURUPA VALLEY",
            "state": "CA",
            "postal_code": "91752",
            "telephone_number": "213-569-1450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 S MAIN ST",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928823420",
            "telephone_number": "213-569-1450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEREK Q PHAN MD MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-09",
        "last_updated": "2023-06-09",
        "certification_date": "2023-06-09",
        "status": "A",
        "authorized_official_last_name": "PHAN",
        "authorized_official_first_name": "DEREK",
        "authorized_official_middle_name": "Q",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "951-324-3157",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Interventional Cardiology Physician in Corona, CA
• Providers in Corona, CA by specialty
• Interventional Cardiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2023; 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.