KIMMY PHAN
NPI 1043843816
Occupational Therapist in Garden Grove, CA

Active since February 19, 2020
11911 WEST ST, GARDEN GROVE, CA 92840(714) 467-9816 Get Directions Write a Review

NPPES record last updated: November 1, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Nov 1, 2021, Feb 19, 2020 (2 updates tracked since 2020).

About Kimmy Phan NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KIMMY PHAN (NPI 1043843816) is an individual occupational therapist in Garden Grove, California, licensed in California (19050) and active in the NPI registry since February 2020.

NPPES Registry Identity

NPI1043843816
Entity TypeIndividualFemale
Primary Taxonomy225X00000X
Provider Legal NameKIMMY PHAN
Location Address11911 WEST STGarden Grove, CA 92840-2552
Mailing Address11911 West StGarden Grove, CA 92840-2552 · (714) 467-9816
Sole ProprietorYes
Enumeration DateFebruary 19, 2020
Last NPPES UpdateNovember 1, 20212 updates tracked since enumeration
NPPES CertifiedNovember 1, 2021
✔ NPI 1043843816 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOccupational TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Taxonomy Code225X00000X
License✔ Licensed in CA · 19050
Definition
An occupational therapist is a person who has graduated from an entry-level occupational therapy program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) or predecessor organizations, or approved by the World Federation of Occupational Therapists (WFOT), or an equivalent international occupational therapy education program; has successfully completed a period of supervised fieldwork experience required by the occupational therapy program; has passed a nationally recognized entry-level examination for occupational therapists, and fulfills state requirements for licensure, certification, or registration. An occupational therapist provides interventions based on evaluation and which emphasize the therapeutic use of everyday life activities (i.e., occupations) with individuals or groups for the purpose of facilitating participation in roles and situations and in home, school, workplace, community and other settings. Occupational therapy services are provided for the purpose of promoting health and wellness and are provided to those who have or are at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, activity limitation, or participation restriction. Occupational therapists address the physical, cognitive, psychosocial, sensory, and other aspects of occupational performance in a variety of contexts to support engagement in everyday life activities that affect health, well-being, and quality of life.
11911 WEST ST, Garden Grove, CA 92840

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kimmy Phan is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Billing Reassignment

Medicare enrollment records show Kimmy Phan reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Clinical Medical Laboratory
13000 PEYTON DR
Chino Hills, CA 91709
  • Reassigned Medicare billing, California enrollment
  • 5,228 clinicians in this Medicare group

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kimmy Phan's NPI number?

The NPI number for Kimmy Phan is 1043843816. It was assigned to this individual provider in the NPPES registry on February 19, 2020.

Where is Kimmy Phan located?

Kimmy Phan practices at 11911 West St, Garden Grove, CA 92840. The listed phone number is (714) 467-9816.

What is Kimmy Phan's specialty?

The primary specialty registered for this NPI is Occupational Therapist with taxonomy code 225X00000X.

Is Kimmy Phan enrolled in Medicare?

Yes. Kimmy Phan is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Kimmy Phan's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kimmy Phan reassigns Medicare benefits to Southern California Permanente Medical Group (Chino Hills, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kimmy Phan's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Kimmy Phan was last updated on November 1, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.