Organization
KELLEY PARK MEDICAL CLINIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER LINH NGUYEN D.O. (DR)
(408) 794-2088
Entity
Organization
Contact information
Practice address
749 STORY RD, SUITE 20, SAN JOSE, CA 95122-2600
(408) 794-2088
(408) 292-2179
Mailing address
749 STORY RD, SUITE 20, SAN JOSE, CA 95122-2600
(408) 794-2088
(408) 292-2179
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
20A7360
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00AX73600
—
CA
01
—
023997
VFC
CA
Enumeration date
02/08/2007
Last updated
08/15/2007
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