Provider Demographics
NPI:1801180104
Name:SOUTH VALLEY SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:SOUTH VALLEY SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNAH HUONG
Authorized Official - Middle Name:THI
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-440-2359
Mailing Address - Street 1:1075 TULLY RD STE A2
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-4237
Mailing Address - Country:US
Mailing Address - Phone:408-440-2359
Mailing Address - Fax:408-677-4341
Practice Address - Street 1:312 VISCAINO WAY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1630
Practice Address - Country:US
Practice Address - Phone:408-440-2359
Practice Address - Fax:408-677-4941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-03
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207X00000X, 208600000X, 363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty