Healthcare Provider Details

I. General information

NPI: 1497621775
Provider Name (Legal Business Name): MR. KEN THOMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 S 2ND ST
SAN JOSE CA
95112-5974
US

IV. Provider business mailing address

1144 S 2ND ST
SAN JOSE CA
95112-5974
US

V. Phone/Fax

Practice location:
  • Phone: 925-914-8973
  • Fax:
Mailing address:
  • Phone: 925-914-8973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: