Healthcare Provider Details

I. General information

NPI: 1710085154
Provider Name (Legal Business Name): NORTHERN CALIFORNIA KIDNEY STONE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16400 LARK AVE STE 100
LAS GATOS CA
95032
US

IV. Provider business mailing address

16400 LARK AVE STE 100
LAS GATOS CA
95032
US

V. Phone/Fax

Practice location:
  • Phone: 408-358-2805
  • Fax: 408-358-2810
Mailing address:
  • Phone: 408-358-2805
  • Fax: 408-358-2810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALLI MOAYED
Title or Position: PRESIDENT
Credential: MD
Phone: 408-358-2805