Provider Demographics
NPI:1275746935
Name:SHIBUYA, BARRY EIICHI (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:EIICHI
Last Name:SHIBUYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3775 BEACON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1466
Mailing Address - Country:US
Mailing Address - Phone:510-791-1300
Mailing Address - Fax:510-791-1301
Practice Address - Street 1:3775 BEACON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1466
Practice Address - Country:US
Practice Address - Phone:510-791-1300
Practice Address - Fax:510-791-1301
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA72682207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A7268210Medicaid