Healthcare Provider Details

I. General information

NPI: 1356979520
Provider Name (Legal Business Name): JEREMY SILVER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 INTERNATIONAL CIR FL 1
SAN JOSE CA
95119-1130
US

IV. Provider business mailing address

260 INTERNATIONAL CIR FL 1
SAN JOSE CA
95119-1130
US

V. Phone/Fax

Practice location:
  • Phone: 408-972-3030
  • Fax:
Mailing address:
  • Phone: 408-972-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA206691
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: