Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kelly Thomas Phan

Individual provider Behavior Technician · NPI 1407609654

Kelly Thomas Phan is a Behavior Technician in Fremont, California. Licensed in California. Registered with an NPI since 2024.

Licensed in
CA
In the registry since
2024

Practice location Address checks out

39210 State St Ste 220
Fremont, CA 94538-1456
Phone: (510) 894-4135
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Behavior Technician (primary) Taxonomy 106S00000X · Licence 46-1305562 (CA)

Record details

NPI number1407609654
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedApril 8, 2024
Last updated in NPPESApril 8, 2024
Certification dateApril 8, 2024
Mailing address255 Union Ave Apt D1073, Campbell, CA 95008-3541

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