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General NPI Number Information
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NPI Number | 1134386576
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Entity Type | Individual
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Provider Name | DEREK FAKHREDEAN AMANATULLAH MD
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Gender | Male
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 04/23/2024
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Provider Practice Location Address
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Address Line | 300 PASTEUR DR
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City | STANFORD
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State | CA
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Zip | 94305-2200
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Country | US
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Telephone | 650-723-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 450 BROADWAY ST, MC 6342 PAVILION C, 4TH FLOOR
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City | REDWOOD CITY
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State | CA
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Zip | 94063-3132
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Country | US
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Telephone | 650-723-2257
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 106870
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 56793
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | A105899
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | A105899
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License Number State | CA
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