Healthcare Provider Details

I. General information

NPI: 1396671046
Provider Name (Legal Business Name): DR. JORDAN HOWARD GREEN MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 N JACKSON AVE STE 205
SAN JOSE CA
95116-1915
US

IV. Provider business mailing address

125 N JACKSON AVE STE 205
SAN JOSE CA
95116-1915
US

V. Phone/Fax

Practice location:
  • Phone: 408-258-6565
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JORDAN HOWARD GREEN
Title or Position: CEO
Credential: MD
Phone: 734-660-9921