| Silicon Valley Ob-gyn Medical Associates Inc. | |
|
150 N. Jackson Ave #209 San Jose CA 95116 | |
| (408) 929-2680 | |
| (408) 929-4635 |
| Full Name | Silicon Valley Ob-gyn Medical Associates Inc. |
|---|---|
| Speciality | Obstetrics & Gynecology |
| Location | 150 N. Jackson Ave #209, San Jose, California |
| Authorized Official Name and Position | Kenneth Phan (CEO) |
| Authorized Official Contact | 4089292680 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Silicon Valley Ob-gyn Medical Associates Inc. Po Box 21827 San Jose CA 95151-1827 Ph: (408) 929-2680 | Silicon Valley Ob-gyn Medical Associates Inc. 150 N. Jackson Ave #209 San Jose CA 95116 Ph: (408) 929-2680 |
| NPI Number | 1780729426 |
|---|---|
| Provider Enumeration Date | 02/20/2007 |
| Last Update Date | 03/28/2019 |
| Medicare PECOS PAC ID | 5698860179 |
|---|---|
| Medicare Enrollment ID | O20070927001085 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780729426 | NPI | - | NPPES |
| 00A771730 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 207VC0200X | Obstetrics & Gynecology - Critical Care Medicine | (* (Not Available)) | Primary |
| Provider Name | Kenneth T Phan |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1336250836 PECOS PAC ID: 8426057464 Enrollment ID: I20061220000342 |
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