Healthcare Provider Details

I. General information

NPI: 1801997440
Provider Name (Legal Business Name): SINAN N. ALSHAHWANY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 06/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 BALFOUR RD SUITE 120
BRENTWOOD CA
94513-4945
US

IV. Provider business mailing address

DEPT 34929 P.O. BOX 39000
SAN FRANCISCO CA
94139-0001
US

V. Phone/Fax

Practice location:
  • Phone: 925-308-8112
  • Fax: 925-308-8710
Mailing address:
  • Phone: 925-952-2828
  • Fax: 925-952-2850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA96392
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA96392
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA96392
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: