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General NPI Number Information
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NPI Number | 1528684628
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Entity Type | Organization
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Legal Business Name | BAY AREA FOOT AND ANKLE MEDICAL CLINIC
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Dates
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Enumeration Date | 06/24/2020
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Last Update Date | 07/20/2020
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Provider Practice Location Address
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Address Line | 3150 ALMADEN EXPY STE 205
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City | SAN JOSE
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State | CA
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Zip | 95118-1253
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Country | US
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Telephone | 650-762-9855
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Fax |
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Provider Business Mailing Address
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Address Line | 353 CORNELL AVE
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City | HAYWARD
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State | CA
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Zip | 94544-8205
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Country | US
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Telephone | 408-518-2504
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. SHENGSHENG GUAN
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Credential | D.P.M.
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Telephone | 408-518-2504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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