Healthcare Provider Details

I. General information

NPI: 1912446410
Provider Name (Legal Business Name): BAY ORIENTAL MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2017
Last Update Date: 02/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 OAKLAND RD STE A104
SAN JOSE CA
95131-2450
US

IV. Provider business mailing address

1630 OAKLAND RD STE A104
SAN JOSE CA
95131-2450
US

V. Phone/Fax

Practice location:
  • Phone: 408-357-4537
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: JEREMY CHAI
Title or Position: MANAGER
Credential:
Phone: 408-357-4537