Healthcare Provider Details

I. General information

NPI: 1699286468
Provider Name (Legal Business Name): ALVIN WALTER ANNEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PASTEUR DR
PALO ALTO CA
94305-2200
US

IV. Provider business mailing address

300 PASTEUR DR
PALO ALTO CA
94305-2200
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberPG193909
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberA202598
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: