Kenneth Phan, M.D.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

A77173 Issued in CA

Practice address

150 N Jackson Ave
Suite 209
San Jose, CA 95116-1908

Phone

(408) 929-2680

Fax

(408) 929-4635

NPI assigned

Aug 31, 2006

Last updated

Apr 29, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Obstetrics/Gynecology

Education

Tufts University School of Medicine, 1998

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: kphan125946@santaclaravalley.direct-ci.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Silicon Valley OB-GYN Medical Associates Inc.

  • Critical Care Medicine (Obstetrics & Gynecology) Physician
  • San Jose, CA
  • NPI 1780729426
  Medicare reassignment NPD Authorized official
• County of Santa Clara

  dba Inpatient Acute/Outpatient Facility Services

  • General Acute Care Hospital
  • San Jose, CA
  • NPI 1063406551
  NPD (past)
• El Camino Health Medical Network, LLC

  • Multi-Specialty Clinic/Center
  • San Jose, CA
  • NPI 1164880761
  NPD (past)
• Good Samaritan Hospital, L.P.

  dba Good Samaritan Hospital

  • General Acute Care Hospital
  • San Jose, CA
  • NPI 1376595777
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1367193600000",
    "number": "1336250836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 N JACKSON AVE",
            "address_2": "SUITE 209",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951161908",
            "telephone_number": "408-929-2680",
            "fax_number": "408-929-4635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 N JACKSON AVE",
            "address_2": "SUITE 209",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951161908",
            "telephone_number": "408-929-2680",
            "fax_number": "408-929-4635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2013-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "A77173",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A771730",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Chanh Phan, MD
• Joseph K Phan
• Kathleen Phan
• Katina D. Phan, DH
• Kelly D Phan
• Kevin Taiduc Phan
• Khanh Phan, DPT
• Kieu Nhi Phan
• Martin Phan, MD
• Nancy D Phan, DDS MS

• Obstetrics & Gynecology Physician in San Jose, CA
• Providers in San Jose, CA by specialty
• Obstetrics & Gynecology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.