Provider Demographics
NPI:1679666994
Name:QAYYUM, MOHAMMED SHAHZAD (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:SHAHZAD
Last Name:QAYYUM
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2550 SAMARITAN DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4104
Mailing Address - Country:US
Mailing Address - Phone:408-610-2001
Mailing Address - Fax:408-610-3880
Practice Address - Street 1:2550 SAMARITAN DR
Practice Address - Street 2:SUITE D
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4104
Practice Address - Country:US
Practice Address - Phone:408-610-2001
Practice Address - Fax:408-610-3880
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56213207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
H22561Medicare UPIN