Provider Demographics
NPI:1528684628
Name:BAY AREA FOOT AND ANKLE MEDICAL CLINIC
Entity type:Organization
Organization Name:BAY AREA FOOT AND ANKLE MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHENGSHENG
Authorized Official - Middle Name:
Authorized Official - Last Name:GUAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:408-518-2504
Mailing Address - Street 1:353 CORNELL AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-8205
Mailing Address - Country:US
Mailing Address - Phone:408-518-2504
Mailing Address - Fax:
Practice Address - Street 1:3150 ALMADEN EXPY STE 205
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-1253
Practice Address - Country:US
Practice Address - Phone:650-762-9855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-24
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty