Provider Demographics
NPI:1376730358
Name:SILICON VALLEY MEDICAL IMAGING INC A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SILICON VALLEY MEDICAL IMAGING INC A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PUNEET
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-595-8687
Mailing Address - Street 1:48912 CROWN RIDGE CMN
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-8331
Mailing Address - Country:US
Mailing Address - Phone:415-595-8687
Mailing Address - Fax:
Practice Address - Street 1:2191 MOWRY AVE STE 500H
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1725
Practice Address - Country:US
Practice Address - Phone:415-595-8687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79514207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ05957ZMedicare PIN