South Bay Cardiovascular Medical Group, Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

A50310 Issued in CA

Legal business name

SOUTH BAY CARDIOVASCULAR MEDICAL GROUP, INC

Practice address

105 N Bascom Ave
Suite 204
San Jose, CA 95128-1811

Phone

(408) 918-0400

Fax

(408) 286-2922

NPI assigned

Feb 2, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mohammad Shenasa, M.D.

Title

Owner

Phone

(408) 918-0400

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1265068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1504051200000",
    "number": "1003148073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 N BASCOM AVE",
            "address_2": "SUITE 204",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951281811",
            "telephone_number": "408-918-0400",
            "fax_number": "408-286-2922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 N BASCOM AVE",
            "address_2": "SUITE 204",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951281811",
            "telephone_number": "408-918-0400",
            "fax_number": "408-286-2922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BAY CARDIOVASCULAR MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-02",
        "last_updated": "2017-08-30",
        "status": "A",
        "authorized_official_last_name": "SHENASA",
        "authorized_official_first_name": "MOHAMMAD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "408-918-0400",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A50310",
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• South Bay Allergy & Asthma Group Inc
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• South Bay Brain and Spine
• South Bay Brain and Spine
• South Bay Cardiology
• South Bay Community Counseling Center
• South Bay Endoscopy Center a Medical Corporation
• South Bay Gi Inc
• South Bay Home Health Care, LLC
• South Bay House-Call Doctor

• Specialist in San Jose, CA
• Providers in San Jose, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.