Provider Demographics
NPI:1164464459
Name:VAUDAGNA, JAMES STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:STEPHEN
Last Name:VAUDAGNA
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 1:3031 TISCH WAY
Mailing Address - Street 2:STE 400
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2541
Mailing Address - Country:US
Mailing Address - Phone:408-244-2100
Mailing Address - Fax:408-244-6596
Practice Address - Street 1:3031 TISCH WAY
Practice Address - Street 2:STE 400
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2541
Practice Address - Country:US
Practice Address - Phone:408-244-2100
Practice Address - Fax:408-244-6596
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA17067174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA20760Medicare UPIN
CA00A170670Medicare PIN