Duke a Phan MD Neurology Inc

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

A51193 Issued in CA

Legal business name

DUKE A PHAN MD NEUROLOGY INC

Practice address

17220 Newhope St
Suite 217
Fountain Valley, CA 92708-4272

Phone

(714) 546-4367

Fax

(714) 546-4361

NPI assigned

Sep 7, 2005

Organization subpart

No

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

Authorized official

Name

Corina Segovia Diaz

Title

Authorized Official

Phone

(714) 334-1215

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Duke An Michael Phan, MD

  • Neurology Physician
  • Fountain Valley, CA
  • NPI 1437352630
  Medicare reassignment NPD

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

{
    "created_epoch": "1126051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1982698767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17220 NEWHOPE ST",
            "address_2": "SUITE 217",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927084272",
            "telephone_number": "714-546-4367",
            "fax_number": "714-546-4361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17220 NEWHOPE ST",
            "address_2": "SUITE 217",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927084272",
            "telephone_number": "714-546-4367",
            "fax_number": "714-546-4361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUKE A PHAN MD NEUROLOGY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-07",
        "last_updated": "2023-03-07",
        "certification_date": "2020-02-28",
        "status": "A",
        "authorized_official_last_name": "SEGOVIA DIAZ",
        "authorized_official_first_name": "CORINA",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "714-334-1215"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CA",
            "license": "A51193",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A511930",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "00A511930",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Duan, MD
• Makenna Nicole Dubois
• Tayzha Kehaunani Dudoit, BT, BA
• Joanna Duesler, MS
• Ulemj Dugarnyam, PA
• Rachel Dulac
• David M Dunckel, MD
• Stephen V. Dundas, DC
• Andre BT Duong, DDS
• Paul Duong

• Neurology Physician in Fountain Valley, CA
• Providers in Fountain Valley, CA by specialty
• Neurology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.