Healthcare Provider Details

I. General information

NPI: 1104322726
Provider Name (Legal Business Name): GRACE PYON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 TROUSDALE DR BLDG B, 5TH FLOOR
BURLINGAME CA
94010-4506
US

IV. Provider business mailing address

PO BOX 276950
SACRAMENTO CA
95827-6950
US

V. Phone/Fax

Practice location:
  • Phone: 650-652-8787
  • Fax:
Mailing address:
  • Phone: 650-652-8787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA196698
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: