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General NPI Number Information
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NPI Number | 1467548297
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Entity Type | Organization
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Legal Business Name | SOUTH BAY ORTHOPEDIC AND SPORTS MEDICINE CLINIC, INC.
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 01/18/2023
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Provider Practice Location Address
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Address Line | 333 OCONNOR DR
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City | SAN JOSE
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State | CA
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Zip | 95128-1623
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Country | US
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Telephone | 408-376-3380
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Fax |
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Provider Business Mailing Address
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Address Line | 2386 BENTLEY RIDGE DR
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City | SAN JOSE
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State | CA
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Zip | 95138-2435
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Country | US
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Telephone | 530-294-1136
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Fax | 530-294-1143
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Authorized Official
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Title or Position | OWNER
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Name | DR. SAMIR SHARMA
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Credential | M.D.
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Telephone | 408-376-3380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | A85279
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | H27947
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License Number State | CA
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