Provider Demographics
NPI:1922005636
Name:SIDDIQUI, SHAHID K (MD)
Entity type:Individual
Prefix:DR
First Name:SHAHID
Middle Name:K
Last Name:SIDDIQUI
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 1:200 JOSE FIGUERES AVE
Mailing Address - Street 2:STE 320
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1500
Mailing Address - Country:US
Mailing Address - Phone:408-926-8100
Mailing Address - Fax:408-926-8103
Practice Address - Street 1:200 JOSE FIGUERES AVE
Practice Address - Street 2:STE 320
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1500
Practice Address - Country:US
Practice Address - Phone:408-926-8100
Practice Address - Fax:408-926-8103
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2013-08-26
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
CA00G844650174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist