Healthcare Provider Details

I. General information

NPI: 1053474981
Provider Name (Legal Business Name): VINITA KAMTHAN-SANJAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 WILLOW RD BLDG 334
MENLO PARK CA
94025-2539
US

IV. Provider business mailing address

795 WILLOW RD BLDG 334
MENLO PARK CA
94025-2539
US

V. Phone/Fax

Practice location:
  • Phone: 650-599-3890
  • Fax:
Mailing address:
  • Phone: 650-599-3890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA76838
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: