Healthcare Provider Details

I. General information

NPI: 1053942813
Provider Name (Legal Business Name): KHALIL CURRY PPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3235 UNION AVE
SAN JOSE CA
95124-2009
US

IV. Provider business mailing address

PO BOX 53090
SAN JOSE CA
95153-0090
US

V. Phone/Fax

Practice location:
  • Phone: 408-371-0960
  • Fax:
Mailing address:
  • Phone: 559-647-9907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number240187688
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: