Healthcare Provider Details

I. General information

NPI: 1669524559
Provider Name (Legal Business Name): SUBHRO KAMAL SEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PASTEUR DR
PALO ALTO CA
94304-2203
US

IV. Provider business mailing address

770 WELCH RD STE 400
PALO ALTO CA
94304-1515
US

V. Phone/Fax

Practice location:
  • Phone: 650-723-4000
  • Fax: 650-725-6605
Mailing address:
  • Phone: 650-723-5824
  • Fax: 650-725-6605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberA104369
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberA104369
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA104369
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: