=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629105549
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EZSTEP INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1460 TULLY RD 604
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95122-3059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-277-0562
-----------------------------------------------------
Fax | 408-277-0592
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1460 TULLY RD 604
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95122-3059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-277-0562
-----------------------------------------------------
Fax | 408-277-0592
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO OWNER
-----------------------------------------------------
Name | DR. EDWARD G KLUJ
-----------------------------------------------------
Credential | PHARM D
-----------------------------------------------------
Telephone | 408-277-0562
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 039428
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------