Active NPI
Khanh Bao Phan, D.O.
- Pediatrics Physician
- Union, NJ
National Provider Identifier
1871804328
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 25MB08718100
- Practice address
- 1651 Earl St
Union, NJ 07083-5531 - Phone
- (908) 591-9200
- NPI assigned
- Jun 30, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 25MB08718100 | NJ | Primary |
Addresses
Primary practice location
1651 Earl St
Union, NJ 07083-5531
Mailing address
1651 Earl St
Union, NJ 07083-5531
Phone (908) 591-9200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ahs Hospital Corp | Past | Accepting new patients |
Organizations & group practices 1
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": "1277856000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1277856000000",
"number": "1871804328",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1651 EARL ST",
"city": "UNION",
"state": "NJ",
"postal_code": "070835531",
"telephone_number": "908-591-9200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1651 EARL ST",
"city": "UNION",
"state": "NJ",
"postal_code": "070835531",
"telephone_number": "908-591-9200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "KHANH",
"middle_name": "BAO",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-06-30",
"last_updated": "2010-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NJ",
"license": "25MB08718100",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Union, NJ
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- Personal Care at Home Inc.
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- Clark E. Philogene, M.D.
- Phoenix Pain Relief Centers, PA
- Colette B Pierce
- Jesse Pierre
- Sephorah Pierre
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.