Healthcare Provider Details

I. General information

NPI: 1780794107
Provider Name (Legal Business Name): JACK ACKERMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 N JACKSON AVE
SAN JOSE CA
95116-1603
US

IV. Provider business mailing address

400 RACE ST
SAN JOSE CA
95126-3518
US

V. Phone/Fax

Practice location:
  • Phone: 408-347-2002
  • Fax: 408-347-2189
Mailing address:
  • Phone: 408-278-3121
  • Fax: 408-278-3194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A6210
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number20A6210
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: