Healthcare Provider Details

I. General information

NPI: 1265547830
Provider Name (Legal Business Name): PADMA MAHAJAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/16/2023
Certification Date: 07/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2242 CAMDEN AVE STE 203
SAN JOSE CA
95124-2029
US

IV. Provider business mailing address

2242 CAMDEN AVE STE 203
SAN JOSE CA
95124-2029
US

V. Phone/Fax

Practice location:
  • Phone: 408-356-7161
  • Fax: 408-356-6676
Mailing address:
  • Phone: 408-356-7161
  • Fax: 408-356-6676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA36338
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: