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

Mr. Bophal Phen

Individual provider Clinical Social Worker · NPI 1750443594

Mr. Bophal Phen is a Clinical Social Worker in San Jose, California. Qualified in 2010, 16 years ago. Practices with Gardner Family Health Network Inc, a 23-clinician group, accepts Medicare assignment and offers telehealth. Licensed in California.

Years since qualifying
16
Licensed in
CA
In the registry since
2006
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Practice location Address checks out

160 E Virginia St #280
San Jose, CA 95112
Phone: (408) 287-6200
Fax: (408) 998-1535
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 29401 (CA)

Record details

NPI number1750443594
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedDecember 15, 2006
Last updated in NPPESFebruary 8, 2023
Certification dateFebruary 8, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2010 (16 years in practice)
Group practice Gardner Family Health Network Inc — 23 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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