Healthcare Provider Details

I. General information

NPI: 1427676873
Provider Name (Legal Business Name): SVETLANA DANI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 11/25/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 SAMARITAN DR
SAN JOSE CA
95124-3907
US

IV. Provider business mailing address

2430 SAMARITAN DR
SAN JOSE CA
95124-3907
US

V. Phone/Fax

Practice location:
  • Phone: 408-559-3888
  • Fax:
Mailing address:
  • Phone: 408-559-3889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: SVETLANA DANI
Title or Position: OWNER
Credential: MD
Phone: 408-559-3889