Healthcare Provider Details

I. General information

NPI: 1023972031
Provider Name (Legal Business Name): HANNAH PHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2025
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3162 NEWBERRY DR STE 10
SAN JOSE CA
95118-1567
US

IV. Provider business mailing address

3162 NEWBERRY DR STE 10
SAN JOSE CA
95118-1567
US

V. Phone/Fax

Practice location:
  • Phone: 408-826-4828
  • Fax: 844-274-2003
Mailing address:
  • Phone: 408-826-4828
  • Fax: 844-274-2003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1379615
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: