1093163388 NPI number — SPECIALIZED SURGEONS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093163388 NPI number — SPECIALIZED SURGEONS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECIALIZED SURGEONS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093163388
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3141 STEVENS CREEK BLVD
Provider Second Line Business Mailing Address:
#351
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95117-1141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
669-284-8181
Provider Business Mailing Address Fax Number:
669-284-8182

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 POLLARD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS GATOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95032-1435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
669-284-8181
Provider Business Practice Location Address Fax Number:
669-284-8181
Provider Enumeration Date:
05/27/2016

Additional Information

Authorized Official

Authorized Official Last Name:
HIRAI
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
206-437-6576

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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