Healthcare Provider Details

I. General information

NPI: 1720157167
Provider Name (Legal Business Name): RONALD K. L. SZETO M.D. A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 TELEGRAPH AVE SUITE 4103
OAKLAND CA
94609-3210
US

IV. Provider business mailing address

3100 TELEGRAPH AVE SUITE 4103
OAKLAND CA
94609-3210
US

V. Phone/Fax

Practice location:
  • Phone: 510-835-7687
  • Fax: 510-835-1140
Mailing address:
  • Phone: 510-835-7687
  • Fax: 510-835-1140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberG32468
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG32468
License Number StateCA

VIII. Authorized Official

Name: DR. RONALD K SZETO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 510-835-7687