Healthcare Provider Details

I. General information

NPI: 1609296441
Provider Name (Legal Business Name): ANUM AHMED M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2014
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12677 ALCOSTA BLVD STE 240
SAN RAMON CA
94583-4413
US

IV. Provider business mailing address

1450 TREAT BLVD STE 300
WALNUT CREEK CA
94597-2168
US

V. Phone/Fax

Practice location:
  • Phone: 925-838-6511
  • Fax:
Mailing address:
  • Phone: 925-952-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC191595
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: