Provider Demographics
NPI:1629386198
Name:SOUTH BAY GI INC
Entity Type:Organization
Organization Name:SOUTH BAY GI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:VITTAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-926-2182
Mailing Address - Street 1:150 N JACKSON AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1908
Mailing Address - Country:US
Mailing Address - Phone:408-926-2182
Mailing Address - Fax:408-926-8370
Practice Address - Street 1:150 N JACKSON AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1908
Practice Address - Country:US
Practice Address - Phone:408-926-2182
Practice Address - Fax:408-926-8370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-18
Last Update Date:2011-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95303207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty