Healthcare Provider Details

I. General information

NPI: 1225386642
Provider Name (Legal Business Name): CALIFORNIA CARDIOVASCULAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 MOWRY AVE SUITE 300
FREMONT CA
94538-1625
US

IV. Provider business mailing address

2333 MOWRY AVE SUITE 300
FREMONT CA
94538-1625
US

V. Phone/Fax

Practice location:
  • Phone: 510-796-0222
  • Fax: 510-796-7760
Mailing address:
  • Phone: 510-796-0222
  • Fax: 510-796-7760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA50605
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG59337
License Number StateCA

VIII. Authorized Official

Name: DR. ASHIT JAIN
Title or Position: CEO
Credential: M.D.
Phone: 510-796-0222