| Dr Philip J Fagan Jr, MD | |
| 14642 Newport Ave Ste 101, Tustin, CA 92780-6058 | |
| (714) 581-6470 | |
| (714) 581-6492 | 
| Full Name | Dr Philip J Fagan Jr | 
|---|---|
| Gender | Male | 
| Speciality | Emergency Medicine | 
| Location | 14642 Newport Ave Ste 101, Tustin, California | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1255335154 | NPI | - | NPPES | 
| 00C325050 | Other | CA | BLUE SHIELD | 
| 00C325050 | Medicaid | CA | |
| 00C325050 | Other | CA | CALOPTIMA | 
| 930085818 | Other | CA | RAILROAD MEDICARE | 
| C32505 | Other | CA | BLUE CROSS | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 207R00000X | Internal Medicine | C32505 (California) | Secondary | 
| 207P00000X | Emergency Medicine | C32505 (California) | Primary | 
| Entity Name | Emergency Department Physicians Medical Group, Inc. | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1730104498 PECOS PAC ID: 2567366800 Enrollment ID: O20031222000734 | 
| Entity Name | Glenn Medical Center, Inc | 
|---|---|
| Entity Type | Part B Supplier - Hospital Department(s) | 
| Entity Identifiers | NPI Number: 1336187178 PECOS PAC ID: 3870505035 Enrollment ID: O20070705000269 | 
| Entity Name | California Hospitalists Emergency Physicians Medical Group Inc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1760648539 PECOS PAC ID: 5193886505 Enrollment ID: O20081203000866 | 
| Entity Name | Knd Development 59 Llc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1740519081 PECOS PAC ID: 3678602802 Enrollment ID: O20100724000249 | 
| Entity Name | Er Physicians Medical Group Inc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1063765907 PECOS PAC ID: 6406008499 Enrollment ID: O20121221000262 | 
| Entity Name | Can Emergency Physicians Medical Group Inc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1265810006 PECOS PAC ID: 8820304462 Enrollment ID: O20150827002595 | 
| Mailing Address | Practice Location Address | 
|---|---|
| Dr Philip J Fagan Jr, MD 2550 N Hollywood Way Ste 304, Burbank, CA 91505-5028 Ph: (747) 283-1809 | Dr Philip J Fagan Jr, MD 14642 Newport Ave Ste 101, Tustin, CA 92780-6058 Ph: (714) 581-6470 | 
| Maxwell Jen, MD Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 17400 Irvine Blvd Ste N, Tustin, CA 92780 Phone: 111-111-1111 | |
| Yusaku Uchimura, MD Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 14662 Newport Ave, Tustin, CA 92780 Phone: 714-669-2000 Fax: 818-587-2493 | |
| Andrew A Tran, MD Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 14662 Newport Ave, Tustin, CA 92780 Phone: 866-266-6980 Fax: 818-587-2493 | |
| Fergus S Ng, MD Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 14662 Newport Ave, Tustin, CA 92780 Phone: 714-669-2000 Fax: 818-587-2493 | |
| Martha Maria Herrero, MD Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 15143 Woodlawn Ave, Tustin, CA 92780 Phone: 714-426-4500 Fax: 714-426-4500 |