Provider Demographics
NPI:1659752798
Name:EVERGREEN SLEEP CENTER
Entity Type:Organization
Organization Name:EVERGREEN SLEEP CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TAM
Authorized Official - Middle Name:HOANG
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:408-258-5083
Mailing Address - Street 1:2110 MCKEE ROAD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1427
Mailing Address - Country:US
Mailing Address - Phone:408-258-5083
Mailing Address - Fax:408-258-4347
Practice Address - Street 1:2365 QUIMBY RD
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-1337
Practice Address - Country:US
Practice Address - Phone:408-258-5083
Practice Address - Fax:408-258-4347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-15
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty