Provider Demographics
NPI:1508176777
Name:PHAN, KIMBERLY YU (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:YU
Last Name:PHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:PO
Other - Last Name:YU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:13980 BLOSSOM HILL RD
Mailing Address - Street 2:STE B
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-5121
Mailing Address - Country:US
Mailing Address - Phone:408-445-8400
Mailing Address - Fax:408-445-0875
Practice Address - Street 1:4860 Y STREET SUITE 3800
Practice Address - Street 2:UC DAVIS HEALTH SYSTEM
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817
Practice Address - Country:US
Practice Address - Phone:916-734-5292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program