Healthcare Provider Details

I. General information

NPI: 1366750846
Provider Name (Legal Business Name): DAVID E.T. STEIN, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2010
Last Update Date: 09/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 SAMARITAN DR STE 1
SAN JOSE CA
95124-3911
US

IV. Provider business mailing address

2440 SAMARITAN DR STE 1
SAN JOSE CA
95124-3911
US

V. Phone/Fax

Practice location:
  • Phone: 408-626-7375
  • Fax: 408-626-7368
Mailing address:
  • Phone: 408-626-7375
  • Fax: 408-626-7368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberG39186
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID E.T. STEIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 408-626-7375