Healthcare Provider Details

I. General information

NPI: 1568456119
Provider Name (Legal Business Name): OCH PATHOLOGY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 FOREST AVE DEPT OF PATHOLOGY
SAN JOSE CA
95128-1425
US

IV. Provider business mailing address

PO BOX 31001-2053
PASADENA CA
91110-2053
US

V. Phone/Fax

Practice location:
  • Phone: 408-947-2518
  • Fax: 408-283-7745
Mailing address:
  • Phone: 408-947-2518
  • Fax: 408-283-7745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHAKU NAGPAL
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 408-947-2518