Healthcare Provider Details

I. General information

NPI: 1932117447
Provider Name (Legal Business Name): JAY LADENHEIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 12/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E EL CAMINO REAL
MOUNTAIN VIEW CA
94040-2833
US

IV. Provider business mailing address

701 E EL CAMINO REAL
MOUNTAIN VIEW CA
94040-2833
US

V. Phone/Fax

Practice location:
  • Phone: 408-739-6000
  • Fax:
Mailing address:
  • Phone: 408-739-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberG68492
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: