Healthcare Provider Details

I. General information

NPI: 1043448996
Provider Name (Legal Business Name): VASANTHA KOLAVENNU JOTWANI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 EL CAMINO REAL
SOUTH SAN FRANCISCO CA
94080-3299
US

IV. Provider business mailing address

1200 EL CAMINO REAL
SOUTH SAN FRANCISCO CA
94080-3299
US

V. Phone/Fax

Practice location:
  • Phone: 650-742-2000
  • Fax:
Mailing address:
  • Phone: 650-742-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA110980
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: