Provider Demographics
NPI:1104388735
Name:SHUJA, AKBAR MOHMMAD
Entity Type:Individual
Prefix:
First Name:AKBAR
Middle Name:MOHMMAD
Last Name:SHUJA
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 1:34274 MIMOSA TER
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-1809
Mailing Address - Country:US
Mailing Address - Phone:408-591-6695
Mailing Address - Fax:
Practice Address - Street 1:34274 MIMOSA TER
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94555-1809
Practice Address - Country:US
Practice Address - Phone:408-591-6695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA18160632OtherKAISER