=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093163388
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPECIALIZED SURGEONS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2016
-----------------------------------------------------
Last Update Date | 07/01/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 825 POLLARD RD
-----------------------------------------------------
City | LOS GATOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95032-1435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 669-284-8181
-----------------------------------------------------
Fax | 669-284-8181
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3141 STEVENS CREEK BLVD #351
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95117-1141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 669-284-8181
-----------------------------------------------------
Fax | 669-284-8182
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | THOMAS HIRAI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 206-437-6576
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------