Healthcare Provider Details

I. General information

NPI: 1275926727
Provider Name (Legal Business Name): HANH PHAN SPEECH & OCCUPATIONAL THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2015
Last Update Date: 05/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6116 CAMINO VERDE DR SUITE 11
SAN JOSE CA
95119-1441
US

IV. Provider business mailing address

6116 CAMINO VERDE DR SUITE 11
SAN JOSE CA
95119-1441
US

V. Phone/Fax

Practice location:
  • Phone: 408-332-0259
  • Fax:
Mailing address:
  • Phone: 408-332-0259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. HANH PHAN
Title or Position: CEO & THERAPIST
Credential: MA, SLP-CCC, OTR-L
Phone: 408-332-0259