Jimmy Phan, PT, DPT

Primary specialty

Geriatric Physical TherapistTaxonomy code 2251G0304X

License

PT293952 Issued in CA

Practice address

24422 Avenida de la Carlota Ste 190
Laguna Hills, CA 92653-3634

Phone

(949) 340-6927

NPI assigned

Jan 25, 2017

Reactivated

Dec 26, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1485302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564963200000",
    "number": "1881131118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24422 AVENIDA DE LA CARLOTA STE 190",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926533634",
            "telephone_number": "949-340-6927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24422 AVENIDA DE LA CARLOTA STE 190",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926533634",
            "telephone_number": "949-340-6927"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10282 Park Ave Apt B",
            "address_purpose": "LOCATION",
            "city": "Garden Grove",
            "state": "CA",
            "postal_code": "928406369",
            "country_code": "US",
            "telephone_number": "714-251-4810",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "68 Willow Rd",
            "address_purpose": "LOCATION",
            "city": "Menlo Park",
            "state": "CA",
            "postal_code": "940253653",
            "country_code": "US",
            "telephone_number": "866-839-6979",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHAN",
        "first_name": "JIMMY",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-01-25",
        "last_updated": "2019-08-05",
        "deactivation_date": "2017-12-06",
        "reactivation_date": "2017-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251G0304X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Geriatrics",
            "state": "CA",
            "license": "PT293952",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Jauregui Pfeifer, RN, IBCLC
• Swapna Vayuvegula Phadnis, M.D.
• Emily Pham, PA-C
• Huyen Pham, PHARM. D
• Joseph Pham
• Pharmaca Integrative Pharmacy, Inc.
• Phillip Cohen MD Apc
• Angela Patricia Phillips-McCord, LMFT
• Dennis S Phillips, MD
• Laura Phillips, LCSW

• Geriatric Physical Therapist in Laguna Hills, CA
• Providers in Laguna Hills, CA by specialty
• Geriatric Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2019; 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.