Provider Demographics
NPI:1083793442
Name:MAH, CHRISTOPHER
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:MAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2147 MOWRY AVE
Mailing Address - Street 2:SUITE D-2
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1724
Mailing Address - Country:US
Mailing Address - Phone:510-793-1583
Mailing Address - Fax:510-793-5691
Practice Address - Street 1:2147 MOWRY AVE
Practice Address - Street 2:SUITE D-2
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1724
Practice Address - Country:US
Practice Address - Phone:510-793-1583
Practice Address - Fax:510-793-5691
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2975213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E29750Medicaid
CA480003813OtherPALMETTO-GBA
CA000E29751Medicaid
CA480002564OtherPALMETTO-GBA
CA5473050001Medicare NSC
CA000E29750Medicare PIN
CA480003813OtherPALMETTO-GBA
CA000E29751Medicare PIN