Provider Demographics
NPI:1265846133
Name:SAN JOSE NEPHROLOGY MEDICAL PRACTICE
Entity Type:Organization
Organization Name:SAN JOSE NEPHROLOGY MEDICAL PRACTICE
Other - Org Name:SAN JOSE NEPHROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-729-7128
Mailing Address - Street 1:2360 MCKEE RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1618
Mailing Address - Country:US
Mailing Address - Phone:408-729-7128
Mailing Address - Fax:408-729-4125
Practice Address - Street 1:2360 MCKEE RD
Practice Address - Street 2:SUITE 10
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1618
Practice Address - Country:US
Practice Address - Phone:408-729-7128
Practice Address - Fax:408-729-4125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty