Provider Demographics
NPI:1679581268
Name:BUHARI, CYRUS (DO)
Entity type:Individual
Prefix:
First Name:CYRUS
Middle Name:
Last Name:BUHARI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 N CALIFORNIA ST
Mailing Address - Street 2:SUITE 14A
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-3757
Mailing Address - Country:US
Mailing Address - Phone:209-942-1005
Mailing Address - Fax:209-942-0455
Practice Address - Street 1:2333 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-5530
Practice Address - Country:US
Practice Address - Phone:209-464-2806
Practice Address - Fax:209-464-1647
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A1923207RC0000X, 207R00000X
CA20A9123207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A1923Medicaid
CAP01226991OtherRAILROAD ROAD
CAP01226991OtherRAILROAD ROAD