MEDICARE: ELISHA BONNY ENG JANG NP, GNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	23355	CA

General Provider Information

NPI Number	:	1780017632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISHA BONNY ENG JANG NP, GNP-BC

Provider Business Mailing Address
First Line	:	299 STOCKTON AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95126-2763
Country	:	US
Telephone Number	:	408-535-4600
Fax Number	:	408-535-4661

Provider Business Practice Location Address
First Line	:	299 STOCKTON AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95126-2763
Country	:	US
Telephone Number	:	408-535-4600
Fax Number	:	408-535-4661

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2013
Last Update Date	:	04/27/2020

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