Provider Demographics
NPI:1720043862
Name:SEN, SABRI (MD)
Entity Type:Individual
Prefix:
First Name:SABRI
Middle Name:
Last Name:SEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:925-776-7725
Mailing Address - Fax:925-754-1869
Practice Address - Street 1:4053 LONE TREE WAY STE 200
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-6210
Practice Address - Country:US
Practice Address - Phone:925-776-7725
Practice Address - Fax:925-754-1869
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52938208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC52938OtherSTATE MEDICAL LICENSE
CA93969OtherUPIN
340000432Medicare ID - Type Unspecified