Provider Demographics
NPI:1902930381
Name:SANTA CLARA CO IPA
Entity Type:Organization
Organization Name:SANTA CLARA CO IPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:J.
Authorized Official - Middle Name:KERSTEN
Authorized Official - Last Name:KRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-358-5834
Mailing Address - Street 1:1051 E. HILLSDALE BLVD
Mailing Address - Street 2:SUITE 750
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-1640
Mailing Address - Country:US
Mailing Address - Phone:650-358-5834
Mailing Address - Fax:650-577-9830
Practice Address - Street 1:1051 E. HILLSDALE BLVD
Practice Address - Street 2:SUITE 750
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-1640
Practice Address - Country:US
Practice Address - Phone:650-358-5834
Practice Address - Fax:650-577-9830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Multi-Specialty