Provider Demographics
NPI:1811121809
Name:EAST BAY PULMONARY SPECIALISTS INC.
Entity type:Organization
Organization Name:EAST BAY PULMONARY SPECIALISTS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BOBBAK
Authorized Official - Middle Name:
Authorized Official - Last Name:VAHID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-990-5978
Mailing Address - Street 1:20410 LAKE CHABOT RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5312
Mailing Address - Country:US
Mailing Address - Phone:510-728-0690
Mailing Address - Fax:
Practice Address - Street 1:198 LASATA CT
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-4401
Practice Address - Country:US
Practice Address - Phone:510-990-5978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97958174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A979580Medicare PIN
CAA52753Medicare UPIN