MEDICARE: DR. YOUSSEF SHAKIB FAHIMI 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	208D00000X	General Practice Physician	C-38789	CA

General Provider Information

NPI Number	:	1659408292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YOUSSEF SHAKIB FAHIMI M.D.

Provider Business Mailing Address
First Line	:	1754 DALTON PL
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95124-5701
Country	:	US
Telephone Number	:	408-978-8289
Fax Number	:	408-978-8289

Provider Business Practice Location Address
First Line	:	1754 DALTON PL
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95124-5701
Country	:	US
Telephone Number	:	408-978-8289
Fax Number	:	408-978-8289

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

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	07/09/2007

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