Healthcare Provider Details

I. General information

NPI: 1205878642
Provider Name (Legal Business Name): KATAYOUN SADRI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6881 CAMPISI CT
SAN JOSE CA
95120-3107
US

IV. Provider business mailing address

6881 CAMPISI CT
SAN JOSE CA
95120-3107
US

V. Phone/Fax

Practice location:
  • Phone: 650-804-0496
  • Fax:
Mailing address:
  • Phone: 650-804-0496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA85562
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: