Healthcare Provider Details

I. General information

NPI: 1063412195
Provider Name (Legal Business Name): MARK M. TSUCHIYOSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 SULLIVAN AVENUE #520
DALY CITY CA
94015
US

IV. Provider business mailing address

1850 SULLIVAN AVENUE #520
DALY CITY CA
94015
US

V. Phone/Fax

Practice location:
  • Phone: 650-756-5000
  • Fax: 650-756-5903
Mailing address:
  • Phone: 650-756-5000
  • Fax: 650-756-5903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberG53160
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: