Quang Quoc Phan, M.D.

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

A44365 Issued in CA

Practice address

12665 Garden Grove Blvd
Suite 304
Garden Grove, CA 92843-1901

Phone

(714) 537-5302

Fax

(714) 537-0592

NPI assigned

Sep 7, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Gastroenterology

Education

University of Mississippi School of Medicine, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Quang Q Phan, MD, Facp, Inc

  • Gastroenterology Physician
  • Garden Grove, CA
  • NPI 1801007679
  Medicare reassignment NPD Authorized official
• Magnolia Surgery Center Limited Partnership

  • Ambulatory Surgical Clinic/Center
  • Westminster, CA
  • NPI 1538159397
  NPD (past)

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

{
    "created_epoch": "1126051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1982698957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12665 GARDEN GROVE BLVD",
            "address_2": "SUITE 304",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928431901",
            "telephone_number": "714-537-5302",
            "fax_number": "714-537-0592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12665 GARDEN GROVE BLVD",
            "address_2": "SUITE 304",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928431901",
            "telephone_number": "714-537-5302",
            "fax_number": "714-537-0592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "QUANG",
        "middle_name": "QUOC",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "CA",
            "license": "A44365",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A443651",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimmy Phan
• Lynda Phan
• Mikey Phan
• Mindy Trieu Phan, D.M.D
• Nguyen Quoc Phan
• Quoc Tran Duy Phan, PHARMD
• Ricky Nguyen Phan, ACNP
• Sandy Diemly Phan, PHARMACIST
• Susie N Phan, PHARM.D
• Thaibinh Tran Phan, M.D.

• Gastroenterology Physician in Garden Grove, CA
• Providers in Garden Grove, CA by specialty
• Gastroenterology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.