Theodore Phan
NPI 1104546969 · Physician Assistant · Novato, CA
Enrolled with Medicare as Practitioner - Physician Assistant · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Theodore Phan is a Physician Assistant provider in Novato, CA (NPI 1104546969).
Provider details
- NPI number
- 1104546969
- Entity type
- Individual
- Primary specialty
- Physician AssistantPhysician Assistants & Advanced Practice Nursing Providers
- Sex
- Male
- Sole proprietor
- Yes
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Student, Health Care
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
3 yrs in NPPES registry
- Profile completeness38% of score
83% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2022-08-31
- Last updated
- 2022-12-05
- Certified
- 2022-12-05
Frequently asked questions
- What is Theodore Phan's NPI number?
- Theodore Phan's National Provider Identifier (NPI) is 1104546969, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What is Theodore Phan's specialty?
- Theodore Phan is listed in the NPPES registry with a primary specialty of Physician Assistant (Physician Assistants & Advanced Practice Nursing Providers).
- Where is Theodore Phan located?
- Theodore Phan's practice location on file with NPPES is 52 Trinity Dr, Novato, CA 94947-5246.
- What is Theodore Phan's phone number?
- The practice phone number listed in the NPPES registry for Theodore Phan is (415) 320-2313.
- Does Theodore Phan accept Medicare?
- Theodore Phan is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Is Theodore Phan's NPI active?
- Yes — Theodore Phan's NPI (1104546969) is active in the NPPES registry as of the last update on 2022-12-05.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.