Provider Demographics
NPI:1083622146
Name:MATSUO ENTERPRISES INC
Entity Type:Organization
Organization Name:MATSUO ENTERPRISES INC
Other - Org Name:SILICON VALLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATSUO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-378-5381
Mailing Address - Street 1:PO BOX 320485
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-0108
Mailing Address - Country:US
Mailing Address - Phone:408-378-5381
Mailing Address - Fax:408-378-1159
Practice Address - Street 1:1550 WINCHESTER BLVD STE 107
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0553
Practice Address - Country:US
Practice Address - Phone:408-378-5381
Practice Address - Fax:408-378-1159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY442280Medicaid
CAPHY442280Medicaid