Provider Demographics
NPI:1558393314
Name:SEHHAT, MINA (MD)
Entity Type:Individual
Prefix:DR
First Name:MINA
Middle Name:
Last Name:SEHHAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 PINE LN
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1646
Mailing Address - Country:US
Mailing Address - Phone:650-935-2935
Mailing Address - Fax:
Practice Address - Street 1:2101 FOREST AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1472
Practice Address - Country:US
Practice Address - Phone:408-975-7680
Practice Address - Fax:408-975-7683
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63182174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G32665Medicare UPIN
CA00A631820Medicare PIN