Healthcare Provider Details

I. General information

NPI: 1811667538
Provider Name (Legal Business Name): SHAHAM KAMKAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: SEAN KAMKAR

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 N JACKSON AVE
SAN JOSE CA
95116-1603
US

IV. Provider business mailing address

225 N JACKSON AVE
SAN JOSE CA
95116-1603
US

V. Phone/Fax

Practice location:
  • Phone: 408-259-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number62319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: