Healthcare Provider Details

I. General information

NPI: 1538981865
Provider Name (Legal Business Name): CAMNY MEDICAL SERVICES WEST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 SOUTH ALMADEN BLVD SUITE 600
SAN JOSE CA
95113
US

IV. Provider business mailing address

99 SOUTH ALMADEN BLVD SUITE 600
SAN JOSE CA
95113
US

V. Phone/Fax

Practice location:
  • Phone: 888-383-5881
  • Fax:
Mailing address:
  • Phone: 888-383-5881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KRISTINE I MCCOY
Title or Position: OPERATIONS ADMINISTRATOR
Credential: MD
Phone: 888-383-5881