Healthcare Provider Details

I. General information

NPI: 1013079110
Provider Name (Legal Business Name): RUSSELL D WOO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WEBSTER ST
SAN FRANCISCO CA
94115-2382
US

IV. Provider business mailing address

2100 WEBSTER ST
SAN FRANCISCO CA
94115-2382
US

V. Phone/Fax

Practice location:
  • Phone: 415-923-3004
  • Fax: 415-982-0629
Mailing address:
  • Phone: 415-923-3004
  • Fax: 415-982-0629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberC33104
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: