1508176777 NPI number — KIMBERLY YU PHAN M.D.

Table of content: KIMBERLY YU PHAN M.D. (NPI 1508176777)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508176777 NPI number — KIMBERLY YU PHAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHAN
Provider First Name:
KIMBERLY
Provider Middle Name:
YU
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YU
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
PO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1508176777
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13980 BLOSSOM HILL RD
Provider Second Line Business Mailing Address:
STE B
Provider Business Mailing Address City Name:
LOS GATOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95032-5121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-445-8400
Provider Business Mailing Address Fax Number:
408-445-0875

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4860 Y STREET SUITE 3800
Provider Second Line Business Practice Location Address:
UC DAVIS HEALTH SYSTEM
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-734-5292
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)