Healthcare Provider Details

I. General information

NPI: 1366394116
Provider Name (Legal Business Name): MUZZAMMIL WAHEED AHMADZADA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2026
Last Update Date: 02/13/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2590 GRANT RD
MOUNTAIN VIEW CA
94040-4302
US

IV. Provider business mailing address

12 FELDIN CT
ELK GROVE CA
95758-8451
US

V. Phone/Fax

Practice location:
  • Phone: 650-940-7000
  • Fax:
Mailing address:
  • Phone: 916-561-9560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: