Healthcare Provider Details

I. General information

NPI: 1487409298
Provider Name (Legal Business Name): SANTA CLARA ANESTHESIA SOLUTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 SAMARITAN DR
SAN JOSE CA
95124-3997
US

IV. Provider business mailing address

15466 LOS GATOS BLVD STE 109-297
LOS GATOS CA
95032-2542
US

V. Phone/Fax

Practice location:
  • Phone: 408-559-2011
  • Fax:
Mailing address:
  • Phone: 669-232-1842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RANDOLPH FUNG
Title or Position: PARTNER
Credential: MD
Phone: 408-438-0478