Healthcare Provider Details

I. General information

NPI: 1104753458
Provider Name (Legal Business Name): ANKUR ANKUR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

766 BOUNTY DR APT 6601
FOSTER CITY CA
94404-2691
US

IV. Provider business mailing address

766 BOUNTY DR APT 6601
FOSTER CITY CA
94404-2691
US

V. Phone/Fax

Practice location:
  • Phone: 864-784-0187
  • Fax:
Mailing address:
  • Phone: 864-784-0187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: