Organization
EXECUTIVE ENDOSCOPY, INC.
Active
Other names
ENDOSCOPY CENTER OF SAN JOSE
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FELIX K. TAM M.D. (CLINIC DIRECTOR/SECRETARY OF ATF CO)
(408) 297-2314
Entity
Organization
Contact information
Practice address
2100 FOREST AVE, SUITE 109, SAN JOSE, CA 95128
(408) 297-2314
(408) 297-2414
Mailing address
2100 FOREST AVE, SUITE 109, SAN JOSE, CA 95128
(408) 297-2314
(408) 297-2414
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
070000639
CA
261QE0800X
Endoscopy Clinic/Center
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SUR01553F
—
CA
Enumeration date
01/12/2007
Last updated
08/15/2008
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