EXECUTIVE ENDOSCOPY INC. NPI 1598815110

NPI Information

EXECUTIVE ENDOSCOPY, INC. is an ambulatory surgical clinic center in San Jose, CA. EXECUTIVE ENDOSCOPY, INC. NPI is 1598815110. The provider is registered as an organization entity type.
The provider Other Name Is Endoscopy Center Of San Jose.

The provider's business location address is:

2100 FOREST AVE
SUITE 109
SAN JOSE, CA
ZIP 95128
Phone: (408) 297-2314
Fax: (408) 297-2414

The provider's authorized official is Felix K. Tam .
The authorized official title is Clinic Director/secretary Of Atf Co and has the following contact phone number (408) 297-2314.

The CLIA number assigned to this NPI record is 05D1039487 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/12/2007 and was last updated on 8/15/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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