Provider Demographics
NPI:1730284092
Name:JOHN C WHITNEY MD, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:JOHN C WHITNEY MD, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WHITNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-379-6750
Mailing Address - Street 1:777 KNOWLES DR STE 3
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1417
Mailing Address - Country:US
Mailing Address - Phone:408-379-6750
Mailing Address - Fax:408-379-1133
Practice Address - Street 1:777 KNOWLES DR STE 3
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1417
Practice Address - Country:US
Practice Address - Phone:408-379-6750
Practice Address - Fax:408-379-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73247208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G732470OtherBLUE SHIELD
CA00G732471OtherMEDICAL
CA00G732471OtherMEDICAL