Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Andrew Tj Phan

Individual provider Registered Nurse · NPI 1720693054

Andrew Tj Phan is a Certified Registered Nurse Anesthetist (CRNA) in San Leandro, California. Qualified in 2020, 6 years ago. Practices with Permanente Medical Group Inc, a 10,941-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
6
Licensed in
CA
In the registry since
2020
Specialties on file
2
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Practice location Address checks out

2500 Merced St
San Leandro, CA 94577-4201
Phone: (510) 454-2069
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence 95001468 (CA)
Registered Nurse Taxonomy 163W00000X · Licence 95035493 (CA)

Record details

NPI number1720693054
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedSeptember 14, 2020
Last updated in NPPESApril 6, 2025
Certification dateApril 6, 2025
Mailing address2500 Merced St, San Leandro, CA 94577-4201

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Permanente Medical Group Inc — 10941 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in San Leandro