Provider Demographics
NPI:1558852731
Name:SOUTH BAY MEDICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:SOUTH BAY MEDICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:JO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-909-1350
Mailing Address - Street 1:1030 E EL CAMINO REAL # 151
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-3759
Mailing Address - Country:US
Mailing Address - Phone:408-909-1350
Mailing Address - Fax:650-590-0972
Practice Address - Street 1:15100 LOS GATOS BLVD STE 1
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2028
Practice Address - Country:US
Practice Address - Phone:408-909-1350
Practice Address - Fax:833-740-3658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-23
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA-147880207RG0300X, 207RR0500X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty