=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366725947
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JYOTHI SARMA MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2011
-----------------------------------------------------
Last Update Date | 02/21/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5720 STONERIDGE MALL ROAD SUITE 260
-----------------------------------------------------
City | PLEASANTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94588-2830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-463-2918
-----------------------------------------------------
Fax | 925-463-2919
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5720 STONERIDGE MALL RD SUITE 260
-----------------------------------------------------
City | PLEASANTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94588-2830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-463-2918
-----------------------------------------------------
Fax | 925-463-2919
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JYOTHI SARMA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 925-463-2918
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | A37640
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------