Healthcare Provider Details

I. General information

NPI: 1801657648
Provider Name (Legal Business Name): KANDU MEDICAL SERVICES EAST CHARTERED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E HACIENDA AVE
CAMPBELL CA
95008-6617
US

IV. Provider business mailing address

210 E HACIENDA AVE
CAMPBELL CA
95008-6617
US

V. Phone/Fax

Practice location:
  • Phone: 833-526-3848
  • Fax:
Mailing address:
  • Phone: 833-526-3848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: NANCEY TREVANIAN TSAI
Title or Position: PRESIDENT, MEDICAL DIRECTOR
Credential: MD
Phone: 833-526-3848