Provider Demographics
NPI:1992701650
Name:CALIFORNIA CARDIOVASCULAR CONSULTANTS MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:CALIFORNIA CARDIOVASCULAR CONSULTANTS MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHIT
Authorized Official - Middle Name:
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-796-0222
Mailing Address - Street 1:1900 MOWRY AVE
Mailing Address - Street 2:STE 309
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1722
Mailing Address - Country:US
Mailing Address - Phone:510-796-0222
Mailing Address - Fax:510-796-7760
Practice Address - Street 1:1900 MOWRY AVE
Practice Address - Street 2:STE 309
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1722
Practice Address - Country:US
Practice Address - Phone:510-796-0222
Practice Address - Fax:510-796-7760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA024681207Q00000X, 207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
55251OtherMEDICAL
ZZZ25956ZOtherMEDICARE
ZZZ17383ZOtherMEDICARE
55252OtherMEDICAL
GR0055250OtherMEDICAL
55252OtherMEDICAL