Healthcare Provider Details

I. General information

NPI: 1023070786
Provider Name (Legal Business Name): BARRY SHIBUYA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 08/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3775 BEACON AVE SUITE 100
FREMONT CA
94538-1466
US

IV. Provider business mailing address

3775 BEACON AVE SUITE 100
FREMONT CA
94538-1466
US

V. Phone/Fax

Practice location:
  • Phone: 510-791-1300
  • Fax: 510-791-1301
Mailing address:
  • Phone: 510-791-1300
  • Fax: 510-791-1301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberA72682
License Number StateCA

VIII. Authorized Official

Name: DR. BARRY EIICHI SHIBUYA
Title or Position: PRESIDENT
Credential: MD
Phone: 510-791-1300