Healthcare Provider Details

I. General information

NPI: 1235564345
Provider Name (Legal Business Name): VANQUYNH PHAM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2013
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 N WHITE RD STE 200
SAN JOSE CA
95127-1966
US

IV. Provider business mailing address

255 N WHITE RD STE 200
SAN JOSE CA
95127-1966
US

V. Phone/Fax

Practice location:
  • Phone: 408-503-7600
  • Fax:
Mailing address:
  • Phone: 510-896-5613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95007555
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number827456
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: