Healthcare Provider Details

I. General information

NPI: 1588828537
Provider Name (Legal Business Name): MALINI DANDU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MALINI DANDU M.D.

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 5TH ST STE 405
SAN FRANCISCO CA
94107-1541
US

IV. Provider business mailing address

6141 RUNNING SPRINGS RD
SAN JOSE CA
95135-2246
US

V. Phone/Fax

Practice location:
  • Phone: 888-713-5540
  • Fax:
Mailing address:
  • Phone: 669-282-7620
  • Fax: 760-956-4156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39126
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA109876
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: