Provider Demographics
NPI:1578586731
Name:SAN JOSE GASTROENTEROLOGY, INC.
Entity Type:Organization
Organization Name:SAN JOSE GASTROENTEROLOGY, INC.
Other - Org Name:SAN JOSE GASTROENTEROLOGY, MEDICAL CORP.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HUY
Authorized Official - Middle Name:NGOC
Authorized Official - Last Name:TRINH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-347-9001
Mailing Address - Street 1:2331 MONTPELIER DR STE B
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1673
Mailing Address - Country:US
Mailing Address - Phone:408-347-9001
Mailing Address - Fax:408-347-9004
Practice Address - Street 1:2331 MONTPELIER DR STE B
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1673
Practice Address - Country:US
Practice Address - Phone:408-347-9001
Practice Address - Fax:408-347-9004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0095030Medicaid
CAGR0095030Medicaid