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General NPI Number Information
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NPI Number | 1780953042
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Entity Type | Organization
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Legal Business Name | JSM SOUTHBAY, PC
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Dates
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Enumeration Date | 12/15/2011
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Last Update Date | 12/15/2011
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Provider Practice Location Address
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Address Line | 14777 LOS GATOS BLVD SUITE 105
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City | LOS GATOS
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State | CA
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Zip | 95032-2059
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Country | US
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Telephone | 925-287-8777
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Fax |
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Provider Business Mailing Address
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Address Line | 595 PRICE AVE SECOND FLOOR
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City | REDWOOD CITY
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State | CA
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Zip | 94063-1464
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Country | US
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Telephone | 925-287-8777
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Fax |
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Authorized Official
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Title or Position | COO
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Name | CONRAD LAI
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Credential | MD
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Telephone | 925-287-8777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | A66219
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207QB0002X
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Taxonomy Name | Obesity Medicine (Family Medicine) Physician
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License Number | A66219
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License Number State | CA
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