Active NPI
Shaelyn T Pham, PH.D.
- Psychologist
- Los Angeles, CA
National Provider Identifier
1902073711
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- Practice address
- 611 Wilshire Blvd Ste 1002
Los Angeles, CA 90017-2906 - Phone
- (213) 842-4584
- NPI assigned
- May 12, 2008
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | Primary |
Addresses
Primary practice location
611 Wilshire Blvd Ste 1002
Los Angeles, CA 90017-2906
Mailing address
24492 Copper Cliff CT
Lake Forest, CA 92630-1949
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230921004089 | CA | Practitioner - Clinical Psychologist | 9032563283 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Psychserves | Current | Accepting new patients | |
| Jillian Greene Psychologist a Professional Corporation | Past | Accepting new patients |
Locations
626 Wilshire Blvd
Ste 910
Los Angeles, CA 90017
Phone (213) 293-4925
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.
-
- Clinical Psychologist
- Los Angeles, CA
- NPI 1831464742
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Los Angeles, CA
- NPI 1750933354
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210550400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718064000000",
"number": "1902073711",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24492 COPPER CLIFF CT",
"city": "LAKE FOREST",
"state": "CA",
"postal_code": "926301949"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "611 WILSHIRE BLVD STE 1002",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900172906",
"telephone_number": "213-842-4584"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAM",
"first_name": "SHAELYN",
"middle_name": "T",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-05-12",
"last_updated": "2024-06-11",
"certification_date": "2024-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.