Healthcare Provider Details

I. General information

NPI: 1679666994
Provider Name (Legal Business Name): MOHAMMED SHAHZAD QAYYUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 SAMARITAN DR SUITE D
SAN JOSE CA
95124-4104
US

IV. Provider business mailing address

2550 SAMARITAN DR SUITE 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 Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA56213
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: