Healthcare Provider Details

I. General information

NPI: 1780694653
Provider Name (Legal Business Name): CENTER FOR GYNECOLOGIC ONCOLOGY AND PELVIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 POLLARD RD ATTN: CGOPS
LOS GATOS CA
95032-1438
US

IV. Provider business mailing address

815 POLLARD RD ATTN: CGOPS
LOS GATOS CA
95032-1438
US

V. Phone/Fax

Practice location:
  • Phone: 408-378-6545
  • Fax: 408-378-6550
Mailing address:
  • Phone: 408-378-6545
  • Fax: 408-378-6550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberG45093, G83323
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberG64782, G21751
License Number StateCA

VIII. Authorized Official

Name: MING-TEH DWIGHT CHEN
Title or Position: ADMINISTRATIVE PARTNER
Credential: M.D.
Phone: 408-378-6545