Basic Information
| Provider Information | |||||||||
| NPI: | 1265846133 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAN JOSE NEPHROLOGY MEDICAL PRACTICE | ||||||||
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| OtherOrganizationName: | SAN JOSE NEPHROLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2360 MCKEE RD | ||||||||
| Address2: | SUITE 10 | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951161618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4087297128 | ||||||||
| FaxNumber: | 4087294125 | ||||||||
| Practice Location | |||||||||
| Address1: | 2360 MCKEE RD | ||||||||
| Address2: | SUITE 10 | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951161618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4087297128 | ||||||||
| FaxNumber: | 4087294125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2014 | ||||||||
| LastUpdateDate: | 06/18/2014 | ||||||||
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| AuthorizedOfficialLastName: | CHEN | ||||||||
| AuthorizedOfficialFirstName: | MAGGIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | MD, CEO | ||||||||
| AuthorizedOfficialTelephone: | 4087297128 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.