Healthcare Provider Details

I. General information

NPI: 1073551677
Provider Name (Legal Business Name): BERNARD LENWOOD HAYMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 N JACKSON AVE
SAN JOSE CA
95116-1603
US

IV. Provider business mailing address

227 N JACKSON AVE
SAN JOSE CA
95116-1603
US

V. Phone/Fax

Practice location:
  • Phone: 408-347-2030
  • Fax: 408-347-2192
Mailing address:
  • Phone: 408-347-2030
  • Fax: 408-347-2192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC37740
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: