Provider Demographics
NPI:1922302397
Name:DASTGAH, AZAR (DPM)
Entity Type:Individual
Prefix:DR
First Name:AZAR
Middle Name:
Last Name:DASTGAH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14651 S BASCOM AVE
Mailing Address - Street 2:SUITE #215
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2014
Mailing Address - Country:US
Mailing Address - Phone:408-358-2250
Mailing Address - Fax:408-358-2258
Practice Address - Street 1:14651 S BASCOM AVE
Practice Address - Street 2:SUITE #215
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2014
Practice Address - Country:US
Practice Address - Phone:408-358-2250
Practice Address - Fax:408-358-2258
Is Sole Proprietor?:No
Enumeration Date:2010-12-29
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4916213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery