Healthcare Provider Details

I. General information

NPI: 1902911381
Provider Name (Legal Business Name): ALEXANDER ADU CLERK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 OCONNOR DR STE 110
SAN JOSE CA
95128-1637
US

IV. Provider business mailing address

455 OCONNOR DR STE 110
SAN JOSE CA
95128-1637
US

V. Phone/Fax

Practice location:
  • Phone: 408-295-4532
  • Fax: 408-295-4738
Mailing address:
  • Phone: 408-295-4532
  • Fax: 408-295-4738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA36573
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code173F00000X
TaxonomySleep Specialist (PhD)
License Number448
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: