Healthcare Provider Details

I. General information

NPI: 1164075529
Provider Name (Legal Business Name): MUBASHIR AYAZ AHMED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2495 HOSPITAL DR STE 460
MOUNTAIN VIEW CA
94040-4172
US

IV. Provider business mailing address

973 UNIVERSITY AVE
LOS GATOS CA
95032-7636
US

V. Phone/Fax

Practice location:
  • Phone: 408-871-3400
  • Fax: 650-447-2044
Mailing address:
  • Phone: 408-871-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA206438
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036159662
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: