=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104719152
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NOVOMED PRIMARY CARE AND AESTHETICS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2025
-----------------------------------------------------
Last Update Date | 01/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14901 NATIONAL AVE STE 203
-----------------------------------------------------
City | LOS GATOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95032-2637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-668-6633
-----------------------------------------------------
Fax | 408-886-5826
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1769 HILLSDALE AVE # 24098
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95124-3111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | SHAHRIAR SHARIF,
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 833-668-6633
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------