Healthcare Provider Details

I. General information

NPI: 1265966600
Provider Name (Legal Business Name): JAMES YAROSLAV YAROVOY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2017
Last Update Date: 09/26/2023
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 N JACKSON AVE
SAN JOSE CA
95116-1603
US

IV. Provider business mailing address

140 SPRUCEMONT PL
SAN JOSE CA
95139-1353
US

V. Phone/Fax

Practice location:
  • Phone: 408-259-5000
  • Fax: 408-729-2884
Mailing address:
  • Phone: 303-709-5560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA165464
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: