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DR. JIMMY NINH HOANG PHAN M.D.
NPI 1770928962
Pediatrics in Lake Elsinore, CA

Active since May 02, 2013
425 DIAMOND DR STE 103, LAKE ELSINORE, CA 92530(951) 981-3122(951) 981-3123 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, Jun 21, 2016, Jan 27, 2016 (3 updates tracked since 2016).

About Dr. Jimmy Ninh Hoang Phan M.d. NPPES

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

DR. JIMMY NINH HOANG PHAN M.D. (NPI 1770928962) is an individual pediatrics provider in Lake Elsinore, California, licensed in California (141765) and active in the NPI registry since May 2013.

NPPES Registry Identity

NPI1770928962
Entity TypeIndividualMale
Primary Taxonomy208000000X
Provider Legal NameDR. JIMMY NINH HOANG PHANCredential: M.D.
Location Address425 DIAMOND DR STE 103Lake Elsinore, CA 92530-4495
Mailing Address425 Diamond Dr Ste 103Lake Elsinore, CA 92530-4495 · (951) 981-3122 · Fax (951) 981-3123
Phone(951) 981-3122
Fax(951) 981-3123
Sole ProprietorYes
Enumeration DateMay 2, 2013
Last NPPES UpdateJanuary 27, 20223 updates tracked since enumeration
NPPES CertifiedJanuary 27, 2022
✔ NPI 1770928962 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in CA · 141765
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 Providers at the Same Location NPPES 3

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

DR. JIMMY PHAN MEDICAL CORPORATION
Pediatrics
425 DIAMOND DR STE 103
LAKE ELSINORE, CA 92530
Riverside County (951) 981-3122
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

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 Jimmy Phan's NPI number?

The NPI number for Jimmy Phan is 1770928962. It was assigned to this individual provider in the NPPES registry on May 2, 2013.

Where is Jimmy Phan located?

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

What is Jimmy Phan's specialty?

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

When was this NPI record last updated?

The NPPES record for Jimmy Phan 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.