Individual
DR. ABID CHRISTOPHER MOGANNAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., M.B.A.
Contact information
Practice address
2425 SAMARITAN DR, SAN JOSE, CA 95124
(408) 559-2011
Mailing address
1900 CAMDEN AVE, STE 101, SAN JOSE, CA 95124-2944
(408) 899-8272
(408) 442-5767
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
A123990
CA
2086S0129X
Vascular Surgery Physician
A123990
CA
2086S0129X
Vascular Surgery Physician
Primary
LT15520
ND
Other
Enumeration date
04/26/2011
Last updated
01/23/2019
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