Provider Demographics
NPI:1326351248
Name:PAINCARE OF SILICON VALLEY, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PAINCARE OF SILICON VALLEY, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-295-8628
Mailing Address - Street 1:2101 FOREST AVE
Mailing Address - Street 2:SUITE 220A
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1448
Mailing Address - Country:US
Mailing Address - Phone:408-295-8628
Mailing Address - Fax:
Practice Address - Street 1:2101 FOREST AVE
Practice Address - Street 2:SUITE 220A
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1448
Practice Address - Country:US
Practice Address - Phone:408-295-8628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty