Provider Demographics
NPI:1366520991
Name:ROOZROKH, HOOTAN C (MD)
Entity type:Individual
Prefix:
First Name:HOOTAN
Middle Name:C
Last Name:ROOZROKH
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 1:14911 NATIONAL AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2632
Mailing Address - Country:US
Mailing Address - Phone:408-688-2149
Mailing Address - Fax:408-688-2505
Practice Address - Street 1:14911 NATIONAL AVE STE 1
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2632
Practice Address - Country:US
Practice Address - Phone:408-688-2149
Practice Address - Fax:408-688-2505
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83949204F00000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A839490Medicaid
CA00A839490Medicaid
00A839490Medicare ID - Type Unspecified