Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1205410131 |
---|---|
Provider Name | Joseph K Phan |
First Address | San Jose, CA 95122-1348 |
Second Address | San Jose, CA 95122-1348 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2021 |
Last Update Date | 06/05/2021 |