Healthcare Provider Details

I. General information

NPI: 1275860421
Provider Name (Legal Business Name): QUALITY FAMILY HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2009
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1167 S KING RD
SAN JOSE CA
95122-2144
US

IV. Provider business mailing address

1167 S KING RD
SAN JOSE CA
95122-2144
US

V. Phone/Fax

Practice location:
  • Phone: 408-926-9937
  • Fax: 408-926-9960
Mailing address:
  • Phone: 408-926-9937
  • Fax: 408-926-9960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberA81236
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberA81236
License Number StateCA

VIII. Authorized Official

Name: BINOYE NAKU
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 408-926-9937