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General NPI Number Information
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NPI Number | 1891858650
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Entity Type | Organization
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Legal Business Name | KHAE SAEPHANH, D.O., INC
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1569 LEXANN AVE SUITE 128
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City | SAN JOSE
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State | CA
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Zip | 95121-1793
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Country | US
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Telephone | 408-274-3200
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Fax | 408-274-8021
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Provider Business Mailing Address
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Address Line | PO BOX 32611
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City | SAN JOSE
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State | CA
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Zip | 95152-2611
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Country | US
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Telephone | 408-274-3200
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Fax | 408-274-8021
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. KHAE VANG SAEPHANH
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Credential | D.O.
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Telephone | 408-274-3200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A9049
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License Number State | CA
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