Healthcare Provider Details

I. General information

NPI: 1679004972
Provider Name (Legal Business Name): RAHUL AMRUTUR SASTRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PARNASSUS AVE # A303
SAN FRANCISCO CA
94143-2202
US

IV. Provider business mailing address

400 PARNASSUS AVE # A303
SAN FRANCISCO CA
94143-2202
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2739
  • Fax:
Mailing address:
  • Phone: 415-353-2739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberLP04320
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberA202222
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: