Provider Demographics
NPI:1396049334
Name:SARKIS BANIPALSIN MD
Entity type:Organization
Organization Name:SARKIS BANIPALSIN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARKIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BANIPALSIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-448-2264
Mailing Address - Street 1:1610 WESTWOOD DR STE 5
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5110
Mailing Address - Country:US
Mailing Address - Phone:408-448-2264
Mailing Address - Fax:408-266-2264
Practice Address - Street 1:1610 WESTWOOD DR STE 5
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5110
Practice Address - Country:US
Practice Address - Phone:408-448-2264
Practice Address - Fax:408-266-2264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-05
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102655261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEG411AMedicare PIN