Healthcare Provider Details

I. General information

NPI: 1508856907
Provider Name (Legal Business Name): FATIMA MOIZ KHAMBATY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 BODEGA DR
SUNNYVALE CA
94086-5740
US

IV. Provider business mailing address

1151 BODEGA DR
SUNNYVALE CA
94086-5740
US

V. Phone/Fax

Practice location:
  • Phone: 408-737-2620
  • Fax:
Mailing address:
  • Phone: 408-737-2620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD034480
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: