Healthcare Provider Details

I. General information

NPI: 1801180104
Provider Name (Legal Business Name): SOUTH VALLEY SURGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2011
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 VISCAINO WAY
SAN JOSE CA
95119-1630
US

IV. Provider business mailing address

1075 TULLY RD STE A2
SAN JOSE CA
95122-4237
US

V. Phone/Fax

Practice location:
  • Phone: 408-440-2359
  • Fax: 408-677-4941
Mailing address:
  • Phone: 408-440-2359
  • Fax: 408-677-4341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name: JENNAH HUONG THI LE
Title or Position: ACCOUNT DIRECTOR
Credential:
Phone: 408-440-2359