Provider Demographics
NPI:1568456119
Name:OCH PATHOLOGY MEDICAL GROUP
Entity Type:Organization
Organization Name:OCH PATHOLOGY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAKU
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGPAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-947-2518
Mailing Address - Street 1:PO BOX 31001-2053
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91110-2053
Mailing Address - Country:US
Mailing Address - Phone:408-947-2518
Mailing Address - Fax:408-283-7745
Practice Address - Street 1:2105 FOREST AVE
Practice Address - Street 2:DEPT OF PATHOLOGY
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1425
Practice Address - Country:US
Practice Address - Phone:408-947-2518
Practice Address - Fax:408-283-7745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0030640Medicaid
CAGR0030640Medicaid