JIMMY PHAN (NPI# 1881131118) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881131118 |
| Entity Type | Individual |
| Full Name | JIMMY PHAN |
| Credential | PT, DPT |
| Practice Address |
24422 Avenida De La Carlota Ste 190 Laguna Hills CA 92653-3634 |
| Practice Telephone | 9493406927 |
| Mailing Telephone | 9493406927 |
| Enumeration Date | 2017-01-25 |
| Last Update Date | 2019-08-05 |
| NPI Deactivation Date | 12/06/2017 |
| NPI Reactivation Date | 2017-12-26 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2251G0304X |
Physical Therapist Specialization: Geriatrics |
PT293952 | CA | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 10282 Park Ave Apt B, Garden Grove, CA 928406369 | 7142514810 | |
| 68 Willow Rd, Menlo Park, CA 940253653 | 8668396979 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770928962 | Jimmy Ninh Hoang Phan | Pediatrics | 900 S Main St, #108, Corona, CA 92882-3401 | 2013-05-02 |
| 1023302213 | Jimmy Phan | Pharmacist | 1731 Manhattan Blvd, Harvey, LA 70058-3409 | 2011-06-05 |
| Street Address |
24422 AVENIDA DE LA CARLOTA STE 190 |
| City | LAGUNA HILLS |
| State | CA |
| Zip Code | 92653-3634 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447679915 | Cecile Ines Roberts-dalli | Physical Therapist | 24422 Avenida De La Carlota Ste 190, Laguna Hills, CA 92653 | 2014-04-14 |
| 1457960098 | Derrick Garner Smith | Speech-Language Pathologist | 24422 Avenida De La Carlota Ste 190, Laguna Hills, CA 92653-3634 | 2020-07-29 |
| 1174141642 | Tia Hein | Speech-Language Pathologist | 24422 Avenida De La Carlota Ste 190, Laguna Hills, CA 92653-3634 | 2020-07-10 |
| 1598386781 | Victoria Clardy | Physical Therapist | 24422 Avenida De La Carlota Ste 190, Laguna Hills, CA 92653-3634 | 2020-04-29 |
| 1003450651 | Kaylie Fisher | Physical Therapist | 24422 Avenida De La Carlota Ste 190, Laguna Hills, CA 92653-3634 | 2019-11-06 |
| 1780228338 | Laura Gonzalez | Physical Therapist | 24422 Avenida De La Carlota Ste 190, Laguna Hills, CA 92653-3634 | 2019-11-06 |
| 1801430459 | Brianna Darneal | Physical Therapist | 24422 Avenida De La Carlota Ste 190, Laguna Hills, CA 92653-3634 | 2019-11-06 |
| 1821647132 | Gail S Skoropad | Physical Therapist | 24422 Avenida De La Carlota Ste 190, Laguna Hills, CA 92653-3634 | 2019-09-09 |
| 1275187643 | Brianna Bacich | Physical Therapist | 24422 Avenida De La Carlota Ste 190, Laguna Hills, CA 92653-3634 | 2019-07-24 |
| 1902463417 | Amanda E Antos | Speech-Language Pathologist | 24422 Avenida De La Carlota Ste 190, Laguna Hills, CA 92653-3634 | 2019-05-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932708476 | Nikkie Veyseh | Behavior Technician | 26921 Falling Leaf Dr., Laguna Hills, CA 92653 | 2020-10-24 |
| 1609480425 | Steve Ceja | Behavior Technician | 25201 Paseo De Alicia Suite 110, Laguna Hills, CA 92653 | 2020-08-31 |
| 1467006882 | Kristina Alexa Puno Morales | Dietitian, Registered | 24552 Health Center Drive, Laguna Hills, CA 92653 | 2019-07-25 |
| 1164929626 | Shoreline Consulting Services, Inc. | Clinic/Center | 23010 Lake Forest Drive, Suite B, Laguna Hills, CA 92653 | 2018-04-11 |
| 1023511045 | Performance Health Medical Group | Non-Pharmacy Dispensing Site | 25431 Cabot Road Suite 118, Laguna Hills, CA 92653 | 2018-03-15 |
| 1831613850 | Stephani A Berg | Physical Medicine & Rehabilitation | 24422 Avenida De La Carlota Suite 190, Laguna Hills, CA 92653 | 2017-08-01 |
| 1497299945 | Stephanie Lyle | Nurse Practitioner | 24221 Calle De Louisa, Suite 400, Laguna Hills, CA 92653 | 2016-12-16 |
| 1053776278 | Meillanny Gladness | Counselor | 23151 Verdugo Dr Ste 203, Laguna Hills, CA 92653 | 2015-12-16 |
| 1912383183 | Pmdca, LLC | Clinical Medical Laboratory | 23297 S Pointe Dr Ste 100, Laguna Hills, CA 92653 | 2015-08-10 |
| 1821486630 | 4mpw, Inc. | Home Health | 23232 Peralta Drive 216, Laguan Hills, CA 92653 | 2014-12-31 |
| Find all providers in zip 92653 | ||||
| Taxonomy Code | 2251G0304X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Physical Therapist |
| Specialization | Geriatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396959144 | Antoinette Grayson | Physical Therapist | 23271 Verdugo Dr Suite B, Laguna Hills, CA 92653 | 2007-05-10 |
| 1730485962 | Focus Therapy Services, Inc | Physical Therapist | 5 Amelia, Laguna Hills, CA 92656-6051 | 2011-02-06 |
| 1942486758 | Rommel Bantog Dijon | Physical Therapist | 23232 Peralta Dr, 113, Laguna Hills, CA 92653-1443 | 2008-01-11 |
| 1306917133 | Sapan Naresh Palkhiwala | Physical Therapist | 24422 Avenida De La Carlota, Suite 190, Laguna Hills, CA 92653-7602 | 2006-11-13 |
| 1508936626 | Complete Balance Solution Institute of Physiotherapy Inc | Physical Therapist | 24422 Avenida De La Carlota, Suite 190, Laguna Hills, CA 92653-7602 | 2006-11-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629679386 | E-care: Physical Therapy Corporation | Physical Therapist | 2856 Pleasant Ct, Rialto, CA 92376-7250 | 2020-11-07 |
| 1083213961 | Profizix Physical Therapy and Wellness P.C. | Physical Therapist | 390 Hauser Blvd Apt 9l, Los Angeles, CA 90036-5577 | 2020-10-21 |
| 1699383000 | Andrea Yin-ming Harwig | Physical Therapist | 21237 Lassen St Unit 3, Chatsworth, CA 91311-6831 | 2020-07-21 |
| 1104443167 | Nadine Fruchter | Physical Therapist | 35 La Linda Dr, Long Beach, CA 90807-3305 | 2020-06-25 |
| 1205458106 | Kristina Louise Nielsen | Physical Therapist | 4213 State St Ste 202, Santa Barbara, CA 93110-2852 | 2020-05-13 |
| 1821627324 | Pamela Shirtz | Physical Therapist | 50 Alessandro Pl # A20, Pasadena, CA 91105-3149 | 2020-04-06 |
| 1235764697 | Alex Cabrera | Physical Therapist | 58 Flor De Sol, Rancho Santa Margarita, CA 92688-1409 | 2020-03-05 |
| 1720619315 | Dwayne Alvin Trenchuk | Physical Therapist | 2 Roquedo, Rancho Santa Margarita, CA 92688-2721 | 2020-02-01 |
| 1629621727 | Chris Curtis | Physical Therapist | 4442 Acorn Ct, Yorba Linda, CA 92886-2331 | 2019-07-18 |
| 1649834730 | Charles David Barnes | Physical Therapist | 404 Estero Ave, Morro Bay, CA 93442 | 2019-04-24 |
| Find all providers with the same taxonomy | ||||
| City | LAGUNA HILLS |
| Zip Code | 92653 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.