Healthcare Provider Details

I. General information

NPI: 1467055764
Provider Name (Legal Business Name): YUPAR SOE LAKEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 N JACKSON AVE
SAN JOSE CA
95116-1907
US

IV. Provider business mailing address

656 DOWNING AVE
SAN JOSE CA
95128-3423
US

V. Phone/Fax

Practice location:
  • Phone: 408-795-3888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP95015345
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberNP95015345
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberNP95015345
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: