Healthcare Provider Details

I. General information

NPI: 1063904829
Provider Name (Legal Business Name): JORDAN HOWARD GREEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
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: 530-622-1441
  • Fax:
Mailing address:
  • Phone: 530-622-1441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberA195801
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA195801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: