MEDICARE: JENNIFER DOMINGO-MIHALKO MD

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	207V00000X	Obstetrics & Gynecology Physician	A64430	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871556431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER DOMINGO-MIHALKO MD

Provider Business Mailing Address
First Line	:	751 S BASCOM AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-2604
Country	:	US
Telephone Number	:	408-885-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	750 S BASCOM AVE
Second Line	:	VHC OB/GYN CLINIC
City	:	SAN JOSE
State	:	CA
Zip	:	95128-2603
Country	:	US
Telephone Number	:	408-885-5550
Fax Number	:

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

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	09/12/2007

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