Healthcare Provider Details

I. General information

NPI: 1821975459
Provider Name (Legal Business Name): HYDRAFIT WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/18/2025
Certification Date: 08/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2741 CHOPIN AVE
SAN JOSE CA
95122-1310
US

IV. Provider business mailing address

3277 S WHITE RD # 228
SAN JOSE CA
95148-4056
US

V. Phone/Fax

Practice location:
  • Phone: 408-230-7679
  • Fax:
Mailing address:
  • Phone: 408-230-7679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ARDEN A PHAN
Title or Position: OWNER & CEO
Credential: RN
Phone: 408-230-7679