Healthcare Provider Details

I. General information

NPI: 1851610745
Provider Name (Legal Business Name): MOSTAFA AHMED SADEK M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 N NAME UNO
GILROY CA
95020-3528
US

IV. Provider business mailing address

838 SEABURY DR
SAN JOSE CA
95136-1849
US

V. Phone/Fax

Practice location:
  • Phone: 408-848-2000
  • Fax:
Mailing address:
  • Phone: 646-642-9393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA175911
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number313492
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: