Healthcare Provider Details

I. General information

NPI: 1609742402
Provider Name (Legal Business Name): JAYAN VARGHEESE PH D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 THOMPSON ST.
MILPITAS CA
95035
US

IV. Provider business mailing address

945 THOMPSON ST
MILPITAS CA
95035
US

V. Phone/Fax

Practice location:
  • Phone: 408-394-5137
  • Fax:
Mailing address:
  • Phone: 408-394-5137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number146207
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: