Healthcare Provider Details

I. General information

NPI: 1992488167
Provider Name (Legal Business Name): YOKO PETTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 08/14/2023
Certification Date: 08/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 TULLY RD STE 304
SAN JOSE CA
95122-3055
US

IV. Provider business mailing address

880 SUMMIT CREEK LN
PLEASANTON CA
94566-3810
US

V. Phone/Fax

Practice location:
  • Phone: 408-271-3900
  • Fax:
Mailing address:
  • Phone: 408-306-7222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: