Healthcare Provider Details

I. General information

NPI: 1679647580
Provider Name (Legal Business Name): JAGAT BHUSHAN SATIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 FORRESTER RD
LOS GATOS CA
95032-6508
US

IV. Provider business mailing address

229 FORRESTER RD
LOS GATOS CA
95032-6508
US

V. Phone/Fax

Practice location:
  • Phone: 408-221-9062
  • Fax: 408-645-6542
Mailing address:
  • Phone: 408-221-9062
  • Fax: 408-645-6542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA26473
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA26473
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: