KELLY D PHAN (NPI# 1306400783) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306400783 |
| Entity Type | Individual |
| Full Name | KELLY D PHAN |
| Practice Address |
2514 Berryessa Rd San Jose CA 95132-2947 |
| Mailing Address |
1308 Isengard Ct San Jose CA 95121-2525 |
| Practice Telephone | 4082721431 |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2019-05-01 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 64703 | CA | Pharmacy Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578721940 | Kelly Myanh Phan | Internal Medicine | Scott and White Hospital, 2401 South 31st Street, Temple, TX 76508-0001 | 2008-06-01 |
| 1295266823 | Kelly Phan | Student in an Organized Health Care Education/Training Program | 1 Baylor Plz, Bcm 320, Houston, TX 77030-3411 | 2017-03-24 |
| 1134553381 | Kelly Nguyen Phan | Physical Therapist | 233 Orangefair Mall, Fullerton, CA 92832-3038 | 2013-08-23 |
| 1760611248 | Kelly Phuong Phan | Optometrist | 18700 Limestone Commercial Dr, Pflugerville, TX 78660-6544 | 2009-07-06 |
| Street Address |
2514 BERRYESSA RD |
| City | SAN JOSE |
| State | CA |
| Zip Code | 95132-2947 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710921549 | Longs Drug Stores California LLC | Pharmacy | 2514 Berryessa Rd, San Jose, CA 95132-2947 | 2006-06-15 |
| 1902415060 | Tram Mendoza | Nurse Practitioner | 2514 Berryessa Rd, San Jose, CA 95132-2947 | 2020-07-24 |
| 1134746514 | Stephen Cheng | Nurse Practitioner | 2514 Berryessa Rd, San Jose, CA 95132-2947 | 2020-07-01 |
| 1356993349 | Cvs Aoc Services, L.L.C. | Technician/Technologist | 2514 Berryessa Rd, San Jose, CA 95132-2947 | 2019-07-10 |
| 1588222079 | Rushika Joshi | Pharmacist | 2514 Berryessa Rd, San Jose, CA 95132-2947 | 2019-05-30 |
| 1154708014 | Soheila Akbarzadeh | Pharmacist | 2514 Berryessa Rd, San Jose, CA 95132-2947 | 2015-04-29 |
| 1679905145 | Maureen Hanley Hannigan | Nurse Practitioner | 2514 Berryessa Rd, San Jose, CA 95132-2947 | 2013-08-06 |
| 1811337470 | Arleen Sta. Maria Comiso | Nurse Practitioner | 2514 Berryessa Rd, San Jose, CA 95132-2947 | 2013-06-27 |
| 1437434693 | Jennifer Vergara Aguila | Nurse Practitioner | 2514 Berryessa Rd, San Jose, CA 95132-2947 | 2011-10-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902300304 | Pamela Judith Reyes | Technician, Other | 2716 Longford Drive, San Jose, CA 95132 | 2018-03-20 |
| 1972990778 | David Thai | Dentist | 2861 Donizetti Ct., San Jose, CA 95132 | 2015-04-20 |
| 1174964092 | Brandi Marche Brooks | Psychologist | 1866 Half Pence Way, San Jose, CA 95132 | 2013-07-08 |
| 1023314325 | Al R Abad Dental Corporation | Dentist | 2664 Berryessa Road, Suite 212, San Jose, CA 95132 | 2011-02-03 |
| 1134355530 | Hang Thuy Tran | Student in an Organized Health Care Education/Training Program | 3314 Hostetter Road, San Jose, CA 95132 | 2009-06-01 |
| 1144408121 | Ruth Elaine Bristol | Marriage & Family Therapist | 3435 Birchwood, San Jose, CA 95132 | 2008-02-01 |
| 1033328398 | Victoria Bethina Andrada | Dentist | 2542 Berryessa Road, San Jose, CA 95132 | 2007-05-22 |
| 1417179540 | Albert G Seid Dds & Hubert G Seid Dds A Professional Corpation | Dentist | 1239 Piedmont Road, San Jose, CA 95132 | 2007-05-02 |
| 1336269554 | Fernando T Vilale | Dentist | 1333 Piedmont Rd#103, San Jose, CA 95132 | 2007-03-30 |
| 1669513172 | Roberto V Espejo Jr Dds Inc | Dentist | 3278 Noble Ave, San Jose, CA 95132 | 2007-02-08 |
| Find all providers in zip 95132 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831714427 | Camille Tran | Pharmacist | 2251 Bellington Ct, San Jose, CA 95138-2469 | 2020-06-10 |
| 1194340604 | Tan Vu | Pharmacist | 4643 Park Norton Pl, San Jose, CA 95136-2523 | 2020-06-10 |
| 1356970974 | Viet Quoc Bui | Pharmacist | 2451 S King Rd Ste A1, San Jose, CA 95122-2540 | 2020-04-06 |
| 1063041903 | Tam Minh To | Pharmacist | 307 Checkers Dr Apt 203, San Jose, CA 95133-2254 | 2020-04-03 |
| 1336777598 | Tina Marie Trinh | Pharmacist | 2707 Glen Loman Way, San Jose, CA 95148-4128 | 2020-03-31 |
| 1487285011 | Nanxi Tang | Pharmacist | 5517 Leigh Ave, San Jose, CA 95124-6128 | 2020-02-02 |
| 1609407410 | Kuan Pei Wu | Pharmacist | 2953 Leigh Ave, San Jose, CA 95124-1635 | 2020-01-30 |
| 1982243135 | Elizabeth Vo | Pharmacist | 3091 Mattos Ave, San Jose, CA 95132-1741 | 2020-01-04 |
| 1093354961 | Truong Thinh Le Thiem | Pharmacist | 1275 Cathay Dr, San Jose, CA 95122-1906 | 2019-12-24 |
| 1306484811 | Tiana Truong | Pharmacist | 2955 Senter Rd Ste 55, San Jose, CA 95111-1200 | 2019-12-16 |
| Find all providers in SAN JOSE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.