Healthcare Provider Details

I. General information

NPI: 1922963834
Provider Name (Legal Business Name): PHI NGO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E CALAVERAS BLVD STE 112
MILPITAS CA
95035-7708
US

IV. Provider business mailing address

1058 BURNTWOOD AVE
SUNNYVALE CA
94089-2640
US

V. Phone/Fax

Practice location:
  • Phone: 408-934-4700
  • Fax:
Mailing address:
  • Phone: 408-507-7183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number54566
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: