Healthcare Provider Details

I. General information

NPI: 1932585874
Provider Name (Legal Business Name): BAY AREA MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N BASCOM AVE 204
SAN JOSE CA
95128-1811
US

IV. Provider business mailing address

105 N BASCOM AVE 204
SAN JOSE CA
95128-1811
US

V. Phone/Fax

Practice location:
  • Phone: 408-918-0400
  • Fax: 408-286-2922
Mailing address:
  • Phone: 408-918-0400
  • Fax: 408-286-2922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA82213
License Number StateCA

VIII. Authorized Official

Name: DR. SHAHRIAR HEIDARY
Title or Position: CARDIOLOGIST
Credential: MD
Phone: 408-761-4671