Healthcare Provider Details

I. General information

NPI: 1326958679
Provider Name (Legal Business Name): MOUMIN AWADELKARIM KHALIL MOHAMED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 QUARRY RD
PALO ALTO CA
94304-1416
US

IV. Provider business mailing address

1007 WHITE DR
SANTA CLARA CA
95051-5316
US

V. Phone/Fax

Practice location:
  • Phone: 650-283-1338
  • Fax:
Mailing address:
  • Phone: 650-283-1338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number992
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: