Healthcare Provider Details

I. General information

NPI: 1619177532
Provider Name (Legal Business Name): CYRUS SHARIAT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 09/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 N. JACKSON AVE. SUITE 105
SAN JOSE CA
95116-1909
US

IV. Provider business mailing address

175 N. JACKSON AVE. SUITE 105
SAN JOSE CA
95116-1909
US

V. Phone/Fax

Practice location:
  • Phone: 408-926-9700
  • Fax: 408-926-9247
Mailing address:
  • Phone: 408-926-9700
  • Fax: 408-926-9247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA115446
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number99999999999999999999
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA115446
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA115446
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: