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KELLEY PARK MEDICAL CLINIC, INC
NPI 1942340625
Clinic/Center - Primary Care in San Jose, CA

Active since February 08, 2007CLIA 05D2145845 · Microscopy
749 STORY RD, SUITE 20, SAN JOSE, CA 95122(408) 794-2088(408) 292-2179 Get Directions Write a Review

NPPES record last updated: August 15, 2007. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Kelley Park Medical Clinic, Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLEY PARK MEDICAL CLINIC, INC (NPI 1942340625) is a healthcare organization registered as a primary care in San Jose, California and active in the NPI registry since February 2007. The organization holds a CLIA Microscopy certificate valid through March 15, 2028 and lists Peter Linh Nguyen, Dr, as its authorized official.

NPPES Registry Identity

NPI1942340625
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameKELLEY PARK MEDICAL CLINIC, INC
Location Address749 STORY RD, SUITE 20San Jose, CA 95122-2600
Mailing Address749 Story Rd, Suite 20San Jose, CA 95122-2600 · (408) 794-2088 · Fax (408) 292-2179
Phone(408) 794-2088
Fax(408) 292-2179
Organization SubpartNo
Authorized OfficialPeter Linh NguyenDr · (408) 794-2088
Enumeration DateFebruary 8, 2007
Last NPPES UpdateAugust 15, 2007
✔ NPI 1942340625 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
License✔ Licensed in CA · 20A7360
749 STORY RD, San Jose, CA 95122
Open in Google Maps ↗

Other Identifiers 4

Other023997CA · Vfc
Medicare UPINH27272CA
Medicaid00AX73600CA
Medicare ID-Type Unspecified020A73601CA

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 05D2145845

Kelley Park Medical Clinic Inc - Peter L Nguyen Do · San Jose, CA
Active · expires Mar 15, 2028
CLIA Number05D2145845
Laboratory TypePhysician Office
Certificate Effective DateMarch 16, 2026
Certificate Expiration DateMarch 15, 2028
Laboratory DirectorPeter Nguyen, Do
Laboratory Phone(408) 794-2088
Laboratory LocationKelley Park Medical Clinic Inc - Peter L Nguyen Do749 Story Rd Ste 20, San Jose, CA 95122
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ASIAN AMERICANS FOR COMMUNITY INVOLVEMENT
Community/Behavioral Health
749 STORY RD
SAN JOSE, CA 95122
Santa Clara County (408) 975-2730
DR. LINH PETER NGUYEN D.O.
Clinic/Center (Primary Care)
749 STORY RD, SUITE 20
SAN JOSE, CA 95122
Santa Clara County (408) 794-2088

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelley Park Medical Clinic, Inc's NPI number?

The NPI number for Kelley Park Medical Clinic, Inc is 1942340625. It was assigned to this organization in the NPPES registry on February 8, 2007.

Where is Kelley Park Medical Clinic, Inc located?

Kelley Park Medical Clinic, Inc is located at 749 Story Rd Suite 20, San Jose, CA 95122. The listed phone number is (408) 794-2088.

What is Kelley Park Medical Clinic, Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Does Kelley Park Medical Clinic, Inc hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 05D2145845) is associated with this NPI, valid through March 15, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Kelley Park Medical Clinic, Inc was last updated on August 15, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.