Healthcare Provider Details

I. General information

NPI: 1982782231
Provider Name (Legal Business Name): SUDIN VITTAL MD ENDOSCOPY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 05/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N JACKSON AVENUE SUITE 107
SAN JOSE CA
95116-1908
US

IV. Provider business mailing address

150 N JACKSON AVENUE SUITE 107
SAN JOSE CA
95116-1908
US

V. Phone/Fax

Practice location:
  • Phone: 408-926-2182
  • Fax: 408-926-8370
Mailing address:
  • Phone: 408-926-2182
  • Fax: 408-926-8370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA252860
License Number StateCA

VIII. Authorized Official

Name: DR. SUDIN VITTAL
Title or Position: OWNER
Credential: M.D.
Phone: 408-926-2182