Healthcare Provider Details

I. General information

NPI: 1982284329
Provider Name (Legal Business Name): MUKHAMMAD BOBUR SULTANOV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BOBUR SULTANOV

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 PARNASSUS AVE
SAN FRANCISCO CA
94143-2206
US

IV. Provider business mailing address

1333 MERIDIAN AVE
SAN JOSE CA
95125-5212
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-1000
  • Fax:
Mailing address:
  • Phone: 408-445-3400
  • Fax: 408-445-1683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA203207
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number1019784
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: