Healthcare Provider Details

I. General information

NPI: 1346160629
Provider Name (Legal Business Name): KYLEE PRINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 ZANKER RD
SAN JOSE CA
95134-2130
US

IV. Provider business mailing address

1464 FERGUSON WAY
SAN JOSE CA
95129-4919
US

V. Phone/Fax

Practice location:
  • Phone: 408-468-0100
  • Fax:
Mailing address:
  • Phone:
  • 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: