Provider Demographics
NPI:1356388516
Name:HOM, BARBARA MAH (MD)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:MAH
Last Name:HOM
Suffix:
Gender:F
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:2006-05-31
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG524790207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G524790Medicaid
C17069Medicare UPIN
CA00G524790Medicare ID - Type Unspecified