| Kelley Park Medical Clinic, Inc | |
|
749 Story Rd Suite 20 San Jose CA 95122-2600 | |
| (408) 794-2088 | |
| (408) 292-2179 |
| Full Name | Kelley Park Medical Clinic, Inc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 749 Story Rd, San Jose, California |
| Authorized Official Name and Position | Peter Linh Nguyen (DR) |
| Authorized Official Contact | 4087942088 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kelley Park Medical Clinic, Inc 749 Story Rd Suite 20 San Jose CA 95122-2600 Ph: (408) 794-2088 | Kelley Park Medical Clinic, Inc 749 Story Rd Suite 20 San Jose CA 95122-2600 Ph: (408) 794-2088 |
| NPI Number | 1942340625 |
|---|---|
| Provider Enumeration Date | 02/08/2007 |
| Last Update Date | 08/15/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942340625 | NPI | - | NPPES |
| 00AX73600 | Medicaid | CA | |
| 023997 | Other | CA | VFC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 20A7360 (California) | Primary |
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