Healthcare Provider Details

I. General information

NPI: 1770085128
Provider Name (Legal Business Name): VAN PHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 WOOL CREEK DR
SAN JOSE CA
95112-2617
US

IV. Provider business mailing address

4433 SACRAMENTO AVE
FREMONT CA
94538-1227
US

V. Phone/Fax

Practice location:
  • Phone: 408-320-6000
  • Fax:
Mailing address:
  • Phone: 510-673-7191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number136474
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: