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2820 Alum Rock Ave Ste 30 San Jose CA 95127-5608 | |
| (408) 937-5058 | |
| (408) 937-1309 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2820 Alum Rock Ave Ste 30, San Jose, California |
| Authorized Official Name and Position | Chau My Phan (CEO/PRESIDENT) |
| Authorized Official Contact | 4089375058 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2820 Alum Rock Ave Ste 30 San Jose CA 95127-5608 Ph: (408) 937-5058 | 2820 Alum Rock Ave Ste 30 San Jose CA 95127-5608 Ph: (408) 937-5058 |
| NPI Number | 1992903967 |
|---|---|
| Provider Enumeration Date | 07/11/2007 |
| Last Update Date | 06/20/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992903967 | NPI | - | NPPES |
| G9348101 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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