Healthcare Provider Details

I. General information

NPI: 1972972776
Provider Name (Legal Business Name): MOHAMMED S. QAYYUM, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2015
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2577 SAMARITAN DR STE 845
SAN JOSE CA
95124-4110
US

IV. Provider business mailing address

4585 STEVENS CREEK BLVD SUITE 101
SANTA CLARA CA
95051-6700
US

V. Phone/Fax

Practice location:
  • Phone: 408-610-2001
  • Fax: 408-610-3880
Mailing address:
  • Phone: 408-298-0433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA56213
License Number StateCA

VIII. Authorized Official

Name: MRS. KRISTI M ZAMORA
Title or Position: BILLING MANAGER
Credential:
Phone: 510-366-6353