Provider Demographics
NPI:1992758973
Name:SAFFOURI, BASSAM GEORGE (MD)
Entity type:Individual
Prefix:MR
First Name:BASSAM
Middle Name:GEORGE
Last Name:SAFFOURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 DARDANELLI LANE
Mailing Address - Street 2:STE 25B
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1419
Mailing Address - Country:US
Mailing Address - Phone:408-370-7801
Mailing Address - Fax:408-370-1175
Practice Address - Street 1:320 DARDANELLI LANE
Practice Address - Street 2:STE 25B
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1419
Practice Address - Country:US
Practice Address - Phone:408-370-7801
Practice Address - Fax:408-370-1175
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA417150207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A417150Medicaid
C21468Medicare UPIN
CA00A417150Medicare ID - Type Unspecified