Provider Demographics
NPI:1598522187
Name:PHAN, ARDEN AMAYUN (RN)
Entity Type:Individual
Prefix:
First Name:ARDEN
Middle Name:AMAYUN
Last Name:PHAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2741 CHOPIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-1310
Mailing Address - Country:US
Mailing Address - Phone:408-230-7679
Mailing Address - Fax:669-766-0080
Practice Address - Street 1:2741 CHOPIN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-1310
Practice Address - Country:US
Practice Address - Phone:408-230-7679
Practice Address - Fax:669-766-0080
Is Sole Proprietor?:No
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95207578163WH0200X, 163WI0500X, 163WP0808X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health