Healthcare Provider Details

I. General information

NPI: 1558393314
Provider Name (Legal Business Name): MINA SEHHAT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 FOREST AVE SUITE 104
SAN JOSE CA
95128-1472
US

IV. Provider business mailing address

255 PINE LN
LOS ALTOS CA
94022-1646
US

V. Phone/Fax

Practice location:
  • Phone: 408-975-7680
  • Fax: 408-975-7683
Mailing address:
  • Phone: 650-935-2935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA63182
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: