Healthcare Provider Details

I. General information

NPI: 1275037681
Provider Name (Legal Business Name): JACK PHILIP SILVA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 E CHEVY CHASE DR STE 430
GLENDALE CA
91206-4140
US

IV. Provider business mailing address

3800 LEGION LN
LOS ANGELES CA
90039-1423
US

V. Phone/Fax

Practice location:
  • Phone: 818-243-1135
  • Fax:
Mailing address:
  • Phone: 916-847-2583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA165012
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: