Healthcare Provider Details

I. General information

NPI: 1780756866
Provider Name (Legal Business Name): PEDIATRIC MEDICAL ASSOCIATES OF EAST BAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CALLAN AVE SUITE 401
SAN LEANDRO CA
94577-4584
US

IV. Provider business mailing address

101 CALLAN AVE SUITE 401
SAN LEANDRO CA
94577-4584
US

V. Phone/Fax

Practice location:
  • Phone: 510-357-7077
  • Fax: 510-357-4363
Mailing address:
  • Phone: 510-357-7077
  • Fax: 510-357-4363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LAWRENCE M NG
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 510-357-7077