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General NPI Number Information
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NPI Number | 1619530912
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Entity Type | Individual
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Provider Name | KHANH PHAN
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Gender | Male
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Dates
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Enumeration Date | 04/22/2019
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 114 ROYCE ST STE E
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City | LOS GATOS
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State | CA
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Zip | 95030-6041
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Country | US
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Telephone | 408-358-1460
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Fax |
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Provider Business Mailing Address
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Address Line | 114 ROYCE ST STE E
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City | LOS GATOS
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State | CA
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Zip | 95030-6041
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Country | US
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Telephone | 408-358-1460
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 25744
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License Number State | CA
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