Provider Demographics
NPI:1942497763
Name:SAN JOSE EAR AND SINUS MEDICAL CENTER
Entity Type:Organization
Organization Name:SAN JOSE EAR AND SINUS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AZAR
Authorized Official - Middle Name:
Authorized Official - Last Name:DARYAEE SAJJADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-358-8507
Mailing Address - Street 1:2577 SAMARITAN DR
Mailing Address - Street 2:845
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4100
Mailing Address - Country:US
Mailing Address - Phone:408-358-8507
Mailing Address - Fax:408-358-8506
Practice Address - Street 1:2577 SAMARITAN DR
Practice Address - Street 2:845
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4100
Practice Address - Country:US
Practice Address - Phone:408-358-8507
Practice Address - Fax:408-358-8506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & NeurotologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ24863ZMedicare PIN