Healthcare Provider Details

I. General information

NPI: 1871592154
Provider Name (Legal Business Name): AMIR TABATABAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15400 NATIONAL AVE STE 201
LOS GATOS CA
95032-2433
US

IV. Provider business mailing address

15400 NATIONAL AVE STE 201
LOS GATOS CA
95032-2433
US

V. Phone/Fax

Practice location:
  • Phone: 408-358-8415
  • Fax: 408-502-9740
Mailing address:
  • Phone: 408-358-8415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberC144611
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD070951L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: