Healthcare Provider Details

I. General information

NPI: 1992641971
Provider Name (Legal Business Name): CARL THADDEUS PANGILINAN KUA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6090 HELLYER AVE
SAN JOSE CA
95138-1055
US

IV. Provider business mailing address

3115 MANDA DR
SAN JOSE CA
95124-2449
US

V. Phone/Fax

Practice location:
  • Phone: 888-688-4965
  • Fax:
Mailing address:
  • Phone: 626-615-0378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: