Healthcare Provider Details

I. General information

NPI: 1487048963
Provider Name (Legal Business Name): EVERGREEN URGENT CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 10/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2365 QUIMBY ROAD SUITE 160
SAN JOSE CA
95122-1337
US

IV. Provider business mailing address

2110 MCKEE RD
SAN JOSE CA
95116-1427
US

V. Phone/Fax

Practice location:
  • Phone: 408-258-5083
  • Fax: 408-258-4347
Mailing address:
  • Phone: 408-258-5083
  • Fax: 408-258-4347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. TAM HOANG NGNYEN
Title or Position: CEO/PHYSICIAN
Credential: D.O.
Phone: 408-258-5083