Healthcare Provider Details

I. General information

NPI: 1235193319
Provider Name (Legal Business Name): DANIEL R KATZENBERG MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 S BASCOM AVE PEDIATRICS DEPARTMENT
SAN JOSE CA
95128-2604
US

IV. Provider business mailing address

25005 ONEONTA DR
LOS ALTOS HILLS CA
94022-5134
US

V. Phone/Fax

Practice location:
  • Phone: 408-885-5440
  • Fax:
Mailing address:
  • Phone: 408-885-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberG71675
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG71675
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberG71675
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: