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MIMI YUN PHAN M.D.
NPI 1770767071
Emergency Medicine in Sacramento, CA

Active since December 21, 2007PECOS Enrolled
4150 V ST, PSSB 2100, SACRAMENTO, CA 95817(916) 734-5010(916) 734-7950 Get Directions Write a Review

NPPES record last updated: December 1, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Dec 1, 2025, Dec 1, 2021 (2 updates tracked since 2021).

About Mimi Yun Phan M.d. NPPES

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

MIMI YUN PHAN M.D. (NPI 1770767071) is an individual emergency medicine provider in Sacramento, California, licensed in California (A102225) and active in the NPI registry since December 2007. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1770767071
Entity TypeIndividualFemale
Primary Taxonomy207P00000X
Provider Legal NameMIMI YUN PHANCredential: M.D.
Location Address4150 V ST, PSSB 2100Sacramento, CA 95817-1460
Mailing Address4150 V St, Pssb 2100Sacramento, CA 95817-1460 · (916) 734-5010 · Fax (916) 734-7950
Phone(916) 734-5010
Fax(916) 734-7950
Sole ProprietorYes
Enumeration DateDecember 21, 2007
Last NPPES UpdateDecember 1, 20252 updates tracked since enumeration
NPPES CertifiedDecember 1, 2025
✔ NPI 1770767071 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyEmergency MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207P00000X
License✔ Licensed in CA · A102225
Definition
An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury.
4150 V ST, Sacramento, CA 95817
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Other Names 1

Former Name (1)Mimi Yun Lee

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mimi Yun Phan M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

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

Southern California Permanente Medical Group
325 mi
Health Maintenance Organization
43112 N 15TH ST
Lancaster, CA 93534
  • Reassigned Medicare billing, California enrollment
  • 13,921 clinicians in this Medicare group
NPI 1982863783 (661) 726-2279

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95817 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$92.61 typical visit price
range $60.44 – $180.85
Typical copayment $23.15 (range $15.11 – $45.21)
Most-billed visit code 99203
Established Patient
$105.95 typical visit price
range $19.88 – $148.15
Typical copayment $26.48 (range $4.97 – $37.03)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

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

KENNETH D. WHEELER CRNA
Nurse Anesthetist, Certified Registered
4150 V ST, PSSB-SUITE 1200, MED: ANESTHESIA
SACRAMENTO, CA 95817
Sacramento County (916) 734-7985
DR. MICHAEL JOHN THORNTON MD
Internal Medicine (Critical Care Medicine)
4150 V ST, SUITE 3400
SACRAMENTO, CA 95817
Sacramento County (916) 734-3566
THOMAS M. GOODNOW CRNA
Nurse Anesthetist, Certified Registered
4150 V ST, PSSB-SUITE 1200, MED: ANESTHESIA
SACRAMENTO, CA 95817
Sacramento County (916) 734-7985
DR. POURIA KASHKOULI M.D.
Internal Medicine
4150 V ST, #3116
SACRAMENTO, CA 95817
Sacramento County (916) 734-7080
DR. ALISON SEMRAD D.O.
Internal Medicine (Endocrinology, Diabetes & Metabolism)
4150 V ST, #3116
SACRAMENTO, CA 95817
Sacramento County (916) 734-7080
DR. DIANE HADDOCK M.D.
Internal Medicine
4150 V ST, #3116
SACRAMENTO, CA 95817
Sacramento County (916) 734-7080
JOHN S MILLAR M.D.
Internal Medicine (Critical Care Medicine)
4150 V ST, SUITE 3400
SACRAMENTO, CA 95817
Sacramento County (916) 734-3564
UC DAVIS
General Acute Care Hospital
4150 V ST, 2100
SACRAMENTO, CA 95817
Sacramento County (916) 734-8583

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 Mimi Phan's NPI number?

The NPI number for Mimi Phan is 1770767071. It was assigned to this individual provider in the NPPES registry on December 21, 2007. The provider is also known as Mimi Yun Lee.

Where is Mimi Phan located?

Mimi Phan practices at 4150 V St Pssb 2100, Sacramento, CA 95817. The listed phone number is (916) 734-5010.

What is Mimi Phan's specialty?

The primary specialty registered for this NPI is Emergency Medicine with taxonomy code 207P00000X.

Is Mimi Phan enrolled in Medicare?

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

Which organization bills Medicare for Mimi Phan's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Mimi Phan reassigns Medicare benefits to Southern California Permanente Medical Group (Lancaster, 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 Mimi 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 Mimi Phan was last updated on December 1, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months 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.