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DR. JIMMY PHAN MEDICAL CORPORATION
NPI 1144989385
Pediatrics in Lake Elsinore, CA

Active since December 15, 2021CLIA 05D2271479 · Waiver
425 DIAMOND DR STE 103, LAKE ELSINORE, CA 92530(951) 981-3122 Get Directions Write a Review

NPPES record last updated: January 27, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jan 27, 2022, Dec 15, 2021 (2 updates tracked since 2021).

About Dr. Jimmy Phan Medical Corporation NPPES

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

DR. JIMMY PHAN MEDICAL CORPORATION (NPI 1144989385), doing business as Lake Elsinore Pediatrics, is a healthcare organization registered as a pediatrics in Lake Elsinore, California and active in the NPI registry since December 2021. The organization holds a CLIA Waiver certificate valid through November 1, 2026 and lists Jimmy Ninh Hoang Phan, Ceo, as its authorized official.

NPPES Registry Identity

NPI1144989385
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameDR. JIMMY PHAN MEDICAL CORPORATION
Location Address425 DIAMOND DR STE 103Lake Elsinore, CA 92530-4495
Mailing Address425 Diamond Dr Ste 103Lake Elsinore, CA 92530-4495 · (951) 981-3122
Phone(951) 981-3122
Organization SubpartNo
Authorized OfficialJimmy Ninh Hoang PhanCeo · (714) 232-9493
Enumeration DateDecember 15, 2021
Last NPPES UpdateJanuary 27, 20222 updates tracked since enumeration
NPPES CertifiedJanuary 27, 2022
✔ NPI 1144989385 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
425 DIAMOND DR STE 103, Lake Elsinore, CA 92530
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Other Names 1

Doing Business AsLake Elsinore Pediatrics

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2271479

Dr Jimmy Phan Medical Corporation Dba Lake Elsinore Pediatrics · Lake Elsinore, CA
Active · expires Nov 1, 2026
CLIA Number05D2271479
Laboratory TypePhysician Office
Certificate Effective DateNovember 2, 2024
Certificate Expiration DateNovember 1, 2026
Laboratory DirectorJimmy N. Phan
Laboratory Phone(951) 571-8794
Laboratory LocationDr Jimmy Phan Medical Corporation Dba Lake Elsinore Pediatrics425 Diamond Drive Ste 103, Lake Elsinore, CA 92530
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SHERREL PARNELL FNP-C
Nurse Practitioner (Family)
425 DIAMOND DR STE 103
LAKE ELSINORE, CA 92530
Riverside County (949) 389-0300
SHAYLA CASANOVA FNP-BC
Nurse Practitioner (Family)
425 DIAMOND DR STE 103
LAKE ELSINORE, CA 92530
Riverside County (951) 981-3122
DR. JIMMY NINH HOANG PHAN M.D.
Pediatrics
425 DIAMOND DR STE 103
LAKE ELSINORE, CA 92530
Riverside County (951) 981-3122

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 Dr. Jimmy Phan Medical Corporation's NPI number?

The NPI number for Dr. Jimmy Phan Medical Corporation is 1144989385. It was assigned to this organization in the NPPES registry on December 15, 2021. The provider is doing business as Lake ELsinore Pediatrics.

Where is Dr. Jimmy Phan Medical Corporation located?

Dr. Jimmy Phan Medical Corporation is located at 425 Diamond Dr Ste 103, Lake Elsinore, CA 92530. The listed phone number is (951) 981-3122.

What is Dr. Jimmy Phan Medical Corporation's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Does Dr. Jimmy Phan Medical Corporation hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2271479) is associated with this NPI, valid through November 1, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Dr. Jimmy Phan Medical Corporation was last updated on January 27, 2022. 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.