Bophal Phen

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

29401 Issued in CA

Practice address

160 E Virginia St
#280
San Jose, CA 95112

Phone

(408) 287-6200

Fax

(408) 998-1535

NPI assigned

Dec 15, 2006

Last updated

Feb 8, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Gardner Family Health Network IncGroup PAC ID 5890859375, 24 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bophal.phen.p1@direct.gardnerfamily.nextgenshare.com

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.

• Gardner Family Health Network, Inc.

  dba Gardner Specialty Service Center

  • Community/Behavioral Health Agency
  • San Jose, CA
  • NPI 1699841528
  Medicare reassignment Care Compare group
• Gardner Family Health Network Inc

  • Federally Qualified Health Center (FQHC)
  • Alviso, CA
  • NPI 1083654545
  NPD

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675814400000",
    "number": "1750443594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 E VIRGINIA ST STE 100",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951125865",
            "telephone_number": "408-938-2137",
            "fax_number": "408-998-1535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 E VIRGINIA ST",
            "address_2": "#280",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "95112",
            "telephone_number": "408-287-6200",
            "fax_number": "408-998-1535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHEN",
        "first_name": "BOPHAL",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-15",
        "last_updated": "2023-02-08",
        "certification_date": "2023-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "29401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yvonne Phan
• Phanle, Inc (Get Well Pharmacy)
• Pharmex, Inc.
• Phelps Dental Corporation (Nor Cal Airway)
• Eric Phelps, DDS, MS
• Sokhamony Chhorn Pheng
• Zippara Pheng
• Anthony Le Phero, MD
• Hoang Phi
• Philip Wolkstein, DMD., Inc

• Clinical Social Worker in San Jose, CA
• Providers in San Jose, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2023; 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.