Healthcare Provider Details

I. General information

NPI: 1366520488
Provider Name (Legal Business Name): SHAREH O GHANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 01/01/2026
Certification Date: 01/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39210 STATE ST STE 100
FREMONT CA
94538-1456
US

IV. Provider business mailing address

39210 STATE ST STE 100
FREMONT CA
94538-1456
US

V. Phone/Fax

Practice location:
  • Phone: 510-451-2000
  • Fax: 510-447-4808
Mailing address:
  • Phone: 510-451-2000
  • Fax: 510-447-4808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number31583
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC133769
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: