Provider Demographics
NPI:1942368444
Name:SHENASA, HOSSEIN (MD)
Entity Type:Individual
Prefix:
First Name:HOSSEIN
Middle Name:
Last Name:SHENASA
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 1:105 N BASCOM AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1811
Mailing Address - Country:US
Mailing Address - Phone:408-918-0400
Mailing Address - Fax:408-286-2922
Practice Address - Street 1:105 N BASCOM AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1811
Practice Address - Country:US
Practice Address - Phone:408-918-0400
Practice Address - Fax:408-286-2922
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53756207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A537560Medicare ID - Type Unspecified
F51059Medicare UPIN