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Individual

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Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1501 TROUSDALE DR, BURLINGAME, CA 94010
(650) 652-8787
Mailing address
325 DISTEL CIR, LOS ALTOS, CA 94022-1408
(650) 652-8787

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
A126722
CA

Other

Enumeration date
04/12/2012
Last updated
06/23/2020
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