Basic Information
Provider Information
NPI: 1497753909
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ASSUDANI
FirstName: ANIL
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D,
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1800 HARRISON ST
Address2: FL 7
City: OAKLAND
State: CA
PostalCode: 946123466
CountryCode: US
TelephoneNumber: 5106256262
FaxNumber:  
Practice Location
Address1: 1150 VETERANS BLVD
Address2: KAISER-REDWOOD CITY, DEPT. OF INPT. PSYCHIATRY
City: REDWOOD CITY
State: CA
PostalCode: 940632037
CountryCode: US
TelephoneNumber: 6502992000
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/08/2005
LastUpdateDate: 12/09/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800XA75568CAY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


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