Provider Demographics
NPI:1598703233
Name:SAN JOSE WOMENS MEDICAL GROUP INC
Entity Type:Organization
Organization Name:SAN JOSE WOMENS MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:FAY SHU
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-358-1804
Mailing Address - Street 1:2504 SAMARITAN DR
Mailing Address - Street 2:STE 20
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4005
Mailing Address - Country:US
Mailing Address - Phone:408-358-1804
Mailing Address - Fax:408-358-1807
Practice Address - Street 1:2504 SAMARITAN DR
Practice Address - Street 2:STE 20
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4005
Practice Address - Country:US
Practice Address - Phone:408-358-1804
Practice Address - Fax:408-358-1807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG082332174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG46940Medicare UPIN
CAZZZ75234ZMedicare ID - Type Unspecified