Active NPI
VI Phan
- Pharmacist
- San Jose, CA
National Provider Identifier
1710362413
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 72663
- Practice address
- 440 Blossom Hill Rd
San Jose, CA 95123-1608 - Phone
- (408) 229-8013
- NPI assigned
- Jul 23, 2015
- Last updated
- Mar 17, 2018
- 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 | 72663 | CA | Primary |
Addresses
Primary practice location
440 Blossom Hill Rd
San Jose, CA 95123-1608
Mailing address
2445 Rinconada Dr Apt 18B
San Jose, CA 95125-2849
Phone (714) 622-8254
Other practice location 1
3860 Decoto Rd
Fremont, CA 94555-3112
Phone (510) 793-9798
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 |
|---|---|---|---|
| 72663 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 3
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1437609600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1710362413",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2445 RINCONADA DR APT 18B",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951252849",
"telephone_number": "714-622-8254"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "440 BLOSSOM HILL RD",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951231608",
"telephone_number": "408-229-8013"
}
],
"practiceLocations": [
{
"address_1": "3860 Decoto Rd",
"address_purpose": "LOCATION",
"city": "Fremont",
"state": "CA",
"postal_code": "945553112",
"country_code": "US",
"telephone_number": "510-793-9798",
"fax_number": "510-793-9484",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PHAN",
"first_name": "VI",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-07-23",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "72663",
"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 Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.