Provider Demographics
NPI:1487684106
Name:SOUTH BAY RETINA INC.
Entity Type:Organization
Organization Name:SOUTH BAY RETINA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KESHAV
Authorized Official - Middle Name:
Authorized Official - Last Name:NARAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-294-3534
Mailing Address - Street 1:455 OCONNOR DR STE 310
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1644
Mailing Address - Country:US
Mailing Address - Phone:408-294-3534
Mailing Address - Fax:408-294-3214
Practice Address - Street 1:455 OCONNOR DR STE 310
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128
Practice Address - Country:US
Practice Address - Phone:408-294-3534
Practice Address - Fax:408-294-3214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG831730207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G831730Medicaid
CA00G831730Medicaid