Provider Demographics
NPI:1588738496
Name:YARISAIED, SHAHAB (DC)
Entity type:Individual
Prefix:DR
First Name:SHAHAB
Middle Name:
Last Name:YARISAIED
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1196 S DE ANZA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-3632
Mailing Address - Country:US
Mailing Address - Phone:408-446-0351
Mailing Address - Fax:
Practice Address - Street 1:1196 S DE ANZA BLVD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-3632
Practice Address - Country:US
Practice Address - Phone:408-446-0351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29531111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor