Individual
DR. KENNETH PHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
150 N JACKSON AVE, SUITE 209, SAN JOSE, CA 95116-1908
(408) 929-2680
(408) 929-4635
Mailing address
150 N JACKSON AVE, SUITE 209, SAN JOSE, CA 95116-1908
(408) 929-2680
(408) 929-4635
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
A77173
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A771730
—
CA
Enumeration date
08/31/2006
Last updated
04/29/2013
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