Healthcare Provider Details

I. General information

NPI: 1174806111
Provider Name (Legal Business Name): MERVYN ALLEN SAHUD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 04/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2633 TELEGRAPH AVE #104
OAKLAND CA
94612-1743
US

IV. Provider business mailing address

4721 DALLAS RANCH RD
ANTIOCH CA
94531-8811
US

V. Phone/Fax

Practice location:
  • Phone: 510-830-3100
  • Fax: 510-830-3316
Mailing address:
  • Phone: 925-778-0679
  • Fax: 925-778-3567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberG11462
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: