Provider Demographics
NPI:1356530406
Name:ASGHAR, FAYAZ (MD)
Entity type:Individual
Prefix:DR
First Name:FAYAZ
Middle Name:
Last Name:ASGHAR
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 1:135 N JACKSON AVE
Mailing Address - Street 2:203
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1917
Mailing Address - Country:US
Mailing Address - Phone:408-926-1202
Mailing Address - Fax:
Practice Address - Street 1:135 N JACKSON AVE
Practice Address - Street 2:203
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1917
Practice Address - Country:US
Practice Address - Phone:408-926-1202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41499207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A414990Medicare PIN
CAA29394Medicare UPIN