Healthcare Provider Details

I. General information

NPI: 1770110322
Provider Name (Legal Business Name): CHAUDY SOTOUDEH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 DISTEL CIR
LOS ALTOS CA
94022-1404
US

IV. Provider business mailing address

PO BOX 276950
SACRAMENTO CA
95827-6950
US

V. Phone/Fax

Practice location:
  • Phone: 650-853-6798
  • Fax: 650-254-5286
Mailing address:
  • Phone: 866-681-0738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A21952
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: