MEDICARE: MDSTX MED SPA PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1477333912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MDSTX MED SPA PC

Provider Business Mailing Address
First Line	:	5700 VILLAGE OAKS DR STE 30
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95123-3768
Country	:	US
Telephone Number	:	408-656-9404
Fax Number	:

Provider Business Practice Location Address
First Line	:	5700 VILLAGE OAKS DR STE 30
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95123-3768
Country	:	US
Telephone Number	:	408-656-9404
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ZESHAAN MAAN
Credential	:	MD
Telephone Number	:	408-656-9404

Provider Enumeration Date	:	10/03/2023
Last Update Date	:	10/03/2023

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