MEDICARE: STANFORD EMPLOYER HEALTH CLINICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1336647114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STANFORD EMPLOYER HEALTH CLINICS

Provider Business Mailing Address
First Line	:	1650 TECHNOLOGY DR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95110-3809
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3165 KIFER RD
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-0804
Country	:	US
Telephone Number	:	669-294-8555
Fax Number	:	669-294-8567

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	LAWRENCE YAU-TUNG KWAN
Credential	:
Telephone Number	:	650-450-0624

Provider Enumeration Date	:	01/26/2018
Last Update Date	:	06/27/2022

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