Healthcare Provider Details

I. General information

NPI: 1487571345
Provider Name (Legal Business Name): TYLER G VON CHRISTIAN DRYE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1870 SENTER RD
SAN JOSE CA
95112-2528
US

IV. Provider business mailing address

1870 SENTER RD
SAN JOSE CA
95112-2528
US

V. Phone/Fax

Practice location:
  • Phone: 669-364-7741
  • Fax:
Mailing address:
  • Phone: 669-364-7741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: