Provider Demographics
NPI:1598715070
Name:SAN JOSE GASTROENTEROLOGY
Entity Type:Organization
Organization Name:SAN JOSE GASTROENTEROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YEN
Authorized Official - Middle Name:LUU
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-213-0063
Mailing Address - Street 1:2340 MONTPELIER DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1622
Mailing Address - Country:US
Mailing Address - Phone:408-213-0063
Mailing Address - Fax:
Practice Address - Street 1:2340 MONTPELIER DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1622
Practice Address - Country:US
Practice Address - Phone:408-213-0063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty