=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366628604
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VALLI A VUJJENI MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2008
-----------------------------------------------------
Last Update Date | 02/02/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2101 FOREST AVE SUITE 120
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95128-1448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-960-1114
-----------------------------------------------------
Fax | 408-960-1115
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 242
-----------------------------------------------------
City | CAMPBELL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95009-0242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-960-1114
-----------------------------------------------------
Fax | 408-960-1115
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. VALLI A. VUJJENI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 408-960-1114
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | A93139
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------