Kelley Park Medical Clinic, Inc

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

20A7360 Issued in CA

Legal business name

KELLEY PARK MEDICAL CLINIC, INC

Practice address

749 Story Rd
Suite 20
San Jose, CA 95122-2600

Phone

(408) 794-2088

Fax

(408) 292-2179

NPI assigned

Feb 8, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Peter Linh Nguyen, D.O.

Title

Dr

Phone

(408) 794-2088

Specialties & licenses 1

Addresses

Other identifiers 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Linh Peter Nguyen, D.O.

  • Primary Care Clinic/Center
  • San Jose, CA
  • NPI 1558353060
  NPD
• La K Dinh

  • Nurse Practitioner
  • San Jose, CA
  • NPI 1932734365
  NPD (past)

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187136000000",
    "number": "1942340625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "749 STORY RD",
            "address_2": "SUITE 20",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951222600",
            "telephone_number": "408-794-2088",
            "fax_number": "408-292-2179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "749 STORY RD",
            "address_2": "SUITE 20",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951222600",
            "telephone_number": "408-794-2088",
            "fax_number": "408-292-2179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLEY PARK MEDICAL CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-08",
        "last_updated": "2007-08-15",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "LINH",
        "authorized_official_title_or_position": "DR",
        "authorized_official_telephone_number": "408-794-2088",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "20A7360",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00AX73600",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VFC",
            "identifier": "023997",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Florence Offenbacher Keller, PHD
• Olivia Keller
• Lisa Kellerman, M.S. CFY-RPE
• Arunasri Kelleti, M.D.,
• Kathy Kellett
• Nirvair Singh Kelley, D.O.
• Roselle Dizon Kelley, PT
• John S. Kellogg, M.D., M.S.
• Kelly Kao Acupuncture &Wellness Center Professional Corporation
• Kelly Lao OD Apc

• Primary Care Clinic/Center in San Jose, CA
• Providers in San Jose, CA by specialty
• Primary Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.