Healthcare Provider Details

I. General information

NPI: 1386319788
Provider Name (Legal Business Name): PAUL DAGUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12390 HILLTOP DR
LOS ALTOS HILLS CA
94024-5218
US

IV. Provider business mailing address

12390 HILLTOP DR
LOS ALTOS HILLS CA
94024-5218
US

V. Phone/Fax

Practice location:
  • Phone: 415-378-5456
  • Fax:
Mailing address:
  • Phone: 415-378-5456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA054549
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: