Healthcare Provider Details

I. General information

NPI: 1609986777
Provider Name (Legal Business Name): EAST BAY CARDIAC SURGERY CENTER MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 WEBSTER ST SUITE 500
OAKLAND CA
94609-3117
US

IV. Provider business mailing address

3300 WEBSTER ST SUITE 500
OAKLAND CA
94609-3117
US

V. Phone/Fax

Practice location:
  • Phone: 510-465-6600
  • Fax: 510-839-0806
Mailing address:
  • Phone: 510-465-6600
  • Fax: 510-839-0806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JUNAID HAMEED KHAN
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 510-465-6600