Healthcare Provider Details

I. General information

NPI: 1689815888
Provider Name (Legal Business Name): NASSER MOIDUDDIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: NASSER JUNAID MOIDUDDIN M.D.

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 WELCH RD
PALO ALTO CA
94304-1601
US

IV. Provider business mailing address

725 WELCH RD
PALO ALTO CA
94304-1601
US

V. Phone/Fax

Practice location:
  • Phone: 650-497-8000
  • Fax:
Mailing address:
  • Phone: 650-497-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0002X
TaxonomyAdult Congenital Heart Disease Physician
License NumberA109143
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA109143
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberA109143
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: