Provider Demographics
NPI:1104822030
Name:KAGEL, ERIC MOSS (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:MOSS
Last Name:KAGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 SAMARITAN DR
Mailing Address - Street 2:STE 208
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4008
Mailing Address - Country:US
Mailing Address - Phone:408-358-3555
Mailing Address - Fax:408-358-3505
Practice Address - Street 1:2505 SAMARITAN DR
Practice Address - Street 2:STE 208
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4008
Practice Address - Country:US
Practice Address - Phone:408-358-3555
Practice Address - Fax:408-358-3505
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2020-02-06
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-22
Provider Licenses
StateLicense IDTaxonomies
CAA72723174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A727230OtherBLUE SHIELD
CAF92728Medicare UPIN
CA00A727230OtherBLUE SHIELD