Provider Demographics
NPI:1417345323
Name:FOOTHILL MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:FOOTHILL MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:JANG-JYH
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-366-0600
Mailing Address - Street 1:10011 N FOOTHILL BLVD
Mailing Address - Street 2:SUITE #105
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-5649
Mailing Address - Country:US
Mailing Address - Phone:408-366-0600
Mailing Address - Fax:408-366-0609
Practice Address - Street 1:10011 N FOOTHILL BLVD
Practice Address - Street 2:SUITE #105
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-5649
Practice Address - Country:US
Practice Address - Phone:408-366-0600
Practice Address - Fax:408-366-0609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty