Active NPI
Sadie Phan, MS, OTR/L
- Occupational Therapist
- San Jose, CA
National Provider Identifier
1558980839
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 19776
- Practice address
- 751 S Bascom Ave
San Jose, CA 95128-2604 - Phone
- (408) 885-5000
- NPI assigned
- Apr 16, 2020
- Last updated
- Dec 4, 2022
- 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 19776 | CA | Primary |
Addresses
Primary practice location
751 S Bascom Ave
San Jose, CA 95128-2604
Mailing address
751 S Bascom Ave
San Jose, CA 95128-2604
Phone (408) 885-5000
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19776 | CA | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1586995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670112000000",
"number": "1558980839",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "751 S BASCOM AVE",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951282604",
"telephone_number": "408-885-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "751 S BASCOM AVE",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951282604",
"telephone_number": "408-885-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "SADIE",
"credential": "MS, OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-04-16",
"last_updated": "2022-12-04",
"certification_date": "2022-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "19776",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"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 Dec 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.