Provider Demographics
NPI:1578688214
Name:ALTAFI, ABDI (MD)
Entity Type:Individual
Prefix:MR
First Name:ABDI
Middle Name:
Last Name:ALTAFI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 N JACKSON AVE
Mailing Address - Street 2:STE 111
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116
Mailing Address - Country:US
Mailing Address - Phone:408-923-3088
Mailing Address - Fax:408-923-2330
Practice Address - Street 1:175 N JACKSON AVE
Practice Address - Street 2:STE 111
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116
Practice Address - Country:US
Practice Address - Phone:408-923-3088
Practice Address - Fax:408-923-2330
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30846207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A308460Medicaid
CA00A308460Medicare ID - Type Unspecified
CAA26252Medicare UPIN