Active NPI
Kelly D Phan
- Pharmacist
- San Jose, CA
National Provider Identifier
1306400783
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 64703
- Practice address
- 2514 Berryessa Rd
San Jose, CA 95132-2947 - Phone
- (408) 272-1431
- NPI assigned
- May 1, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 64703 | CA | Primary |
Addresses
Primary practice location
2514 Berryessa Rd
San Jose, CA 95132-2947
Mailing address
1308 Isengard CT
San Jose, CA 95121-2525
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Na |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 64703 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1556668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1556668800000",
"number": "1306400783",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1308 ISENGARD CT",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951212525"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2514 BERRYESSA RD",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951322947",
"telephone_number": "408-272-1431"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "KELLY",
"middle_name": "D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-05-01",
"last_updated": "2019-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "64703",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Na",
"affiliation": "N",
"address_1": "2514 Berryessa Rd",
"city": "San Jose",
"state": "CA",
"country_code": "US",
"postal_code": "951322947",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.