Healthcare Provider Details

I. General information

NPI: 1316885346
Provider Name (Legal Business Name): ANAM EHSAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7375 ROLLINGDELL DR APT 111
CUPERTINO CA
95014-5852
US

IV. Provider business mailing address

7375 ROLLINGDELL DR APT 111
CUPERTINO CA
95014-5852
US

V. Phone/Fax

Practice location:
  • Phone: 413-362-6120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number10829612
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: