Provider Demographics
NPI:1508908518
Name:SAN JOSE ORTHOPEDIC ASSOCIATES MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SAN JOSE ORTHOPEDIC ASSOCIATES MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:IRA
Authorized Official - Last Name:GOLOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-358-8300
Mailing Address - Street 1:2505 SAMARITAN DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4008
Mailing Address - Country:US
Mailing Address - Phone:408-358-8300
Mailing Address - Fax:408-358-8301
Practice Address - Street 1:2505 SAMARITAN DR
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4008
Practice Address - Country:US
Practice Address - Phone:408-358-8300
Practice Address - Fax:408-358-8301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33893174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA7662OtherRAILROAD MEDICARE
CAZZZ02894ZOtherBLUE SHIELD OF CALIFORNIA
CAZZZ16153ZMedicare Oscar/Certification
CA0577650001Medicare NSC