Revervale Psychotherapy PC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

REVERVALE PSYCHOTHERAPY PC

Practice address

1636 Watson CT
Milpitas, CA 95035-6822

Phone

(650) 714-7595

Fax

(669) 235-8105

NPI assigned

Jan 6, 2021

Organization subpart

No

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

Authorized official

Name

Vinh Q Thai, MDNPI 1205859758

Title

President

Phone

(650) 714-7595

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 1

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

• Vinh Q Thai, MD

  • Psychiatry Physician
  • Milpitas, CA
  • NPI 1205859758
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1609891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672358400000",
    "number": "1962090761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1636 WATSON CT",
            "city": "MILPITAS",
            "state": "CA",
            "postal_code": "950356822",
            "telephone_number": "650-714-7595",
            "fax_number": "669-235-8105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1636 WATSON CT",
            "city": "MILPITAS",
            "state": "CA",
            "postal_code": "950356822",
            "telephone_number": "650-714-7595",
            "fax_number": "669-235-8105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVERVALE PSYCHOTHERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-06",
        "last_updated": "2022-12-30",
        "certification_date": "2022-12-30",
        "status": "A",
        "authorized_official_last_name": "THAI",
        "authorized_official_first_name": "VINH",
        "authorized_official_middle_name": "Q",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "650-714-7595",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Milpitas, CA
• Providers in Milpitas, CA by specialty
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.