Healthcare Provider Details

I. General information

NPI: 1649647736
Provider Name (Legal Business Name): MOHAMMED S. QAYYUM M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 SAMARITAN DR D
SAN JOSE CA
95124-4104
US

IV. Provider business mailing address

2550 SAMARITAN DR D
SAN JOSE CA
95124-4104
US

V. Phone/Fax

Practice location:
  • Phone: 408-610-2001
  • Fax: 408-610-3880
Mailing address:
  • Phone: 408-610-2001
  • Fax: 408-610-3880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA56213
License Number StateCA

VIII. Authorized Official

Name: DR. MOHAMMED S QAYYUM
Title or Position: OWNER
Credential: M.D.
Phone: 408-298-0433