Provider Demographics
NPI:1487691606
Name:TAY, JAFAR (MD)
Entity type:Individual
Prefix:DR
First Name:JAFAR
Middle Name:
Last Name:TAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:175 N JACKSON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1909
Mailing Address - Country:US
Mailing Address - Phone:408-258-8760
Mailing Address - Fax:408-258-3645
Practice Address - Street 1:175 N JACKSON AVE STE 201
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1909
Practice Address - Country:US
Practice Address - Phone:408-258-8760
Practice Address - Fax:408-258-3645
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA695582086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A695580Medicaid
CAA69558OtherSTATE MEDICAL LICENSE
I16144Medicare UPIN
CA00A695580Medicaid