Healthcare Provider Details

I. General information

NPI: 1780729426
Provider Name (Legal Business Name): SILICON VALLEY OB-GYN MEDICAL ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 03/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N. JACKSON AVE #209
SAN JOSE CA
95116
US

IV. Provider business mailing address

PO BOX 21827
SAN JOSE CA
95151-1827
US

V. Phone/Fax

Practice location:
  • Phone: 408-929-2680
  • Fax: 408-929-4635
Mailing address:
  • Phone: 408-929-2680
  • Fax: 408-929-4635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VC0200X
TaxonomyCritical Care Medicine (Obstetrics & Gynecology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KENNETH PHAN
Title or Position: CEO
Credential: MD
Phone: 408-929-2680