Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 106870 | MN |
N | 207X00000X | Orthopaedic Surgeon | 56793 | MN |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | A105899 | CA |
NPI | 1134386576 |
---|---|
Provider Name | Derek Fakhredean Amanatullah |
First Address | Redwood City, CA 94063-3132 |
Second Address | Redwood City, CA 94063-3132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2008 |
Last Update Date | 04/10/2016 |