Healthcare Provider Details

I. General information

NPI: 1467835991
Provider Name (Legal Business Name): STEPHEN AN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2015
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CARLTON AVE STE 200
LOS GATOS CA
95032-2629
US

IV. Provider business mailing address

350 N 2ND ST APT 119
SAN JOSE CA
95112-4091
US

V. Phone/Fax

Practice location:
  • Phone: 408-358-6234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5456
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: