Healthcare Provider Details

I. General information

NPI: 1205280526
Provider Name (Legal Business Name): SILICON VALLEY MEDICAL CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 S PARK VICTORIA DR
MILPITAS CA
95035-6942
US

IV. Provider business mailing address

1113 S PARK VICTORIA DR
MILPITAS CA
95035-6942
US

V. Phone/Fax

Practice location:
  • Phone: 408-945-0300
  • Fax: 408-946-7533
Mailing address:
  • Phone: 408-945-0300
  • Fax: 408-946-7533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA35561
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number132333
License Number StateCA

VIII. Authorized Official

Name: NEEMA B MALHOTRA
Title or Position: CEO
Credential: M.D.
Phone: 408-674-6500