Healthcare Provider Details

I. General information

NPI: 1649258005
Provider Name (Legal Business Name): KURT N BAUSBACK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 03/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2581 SAMARITAN DR STE 202
SAN JOSE CA
95124-4113
US

IV. Provider business mailing address

2350 W. EL CAMINO REAL 2ND FLOOR
MOUNTAIN VIEW CA
94040-6203
US

V. Phone/Fax

Practice location:
  • Phone: 408-358-3939
  • Fax: 408-358-3797
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberG57335
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: