MEDICARE: NAYYAR MUMTAZ MASOOD M.D.

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	207R00000X	Internal Medicine Physician	A051888	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A051888	OTHER	CA	CALIFORNIA STATE LICENSE

General Provider Information

NPI Number	:	1639499866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAYYAR MUMTAZ MASOOD M.D.

Provider Business Mailing Address
First Line	:	5855 SILVER CREEK VALLEY RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95138-1059
Country	:	US
Telephone Number	:	408-574-9100
Fax Number	:

Provider Business Practice Location Address
First Line	:	5855 SILVER CREEK VALLEY RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95138-1059
Country	:	US
Telephone Number	:	408-574-9100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2010
Last Update Date	:	01/18/2022

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