Healthcare Provider Details

I. General information

NPI: 1679705735
Provider Name (Legal Business Name): MR. KAJALLA I AZIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2009
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 LOMA ALTA AVE
LOS GATOS CA
95030
US

IV. Provider business mailing address

499 LOMA ALTA AVE
LOS GATOS CA
95030
US

V. Phone/Fax

Practice location:
  • Phone: 831-794-2777
  • Fax: 831-794-2777
Mailing address:
  • Phone: 831-449-7974
  • Fax: 831-449-1993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: