Healthcare Provider Details

I. General information

NPI: 1619687795
Provider Name (Legal Business Name): PENINSULA MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2022
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N SAN MATEO DR STE 10
SAN MATEO CA
94401-2674
US

IV. Provider business mailing address

215 N SAN MATEO DR STE 10
SAN MATEO CA
94401-2674
US

V. Phone/Fax

Practice location:
  • Phone: 650-666-3644
  • Fax: 650-889-4036
Mailing address:
  • Phone: 650-666-3644
  • Fax: 650-889-4036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ZAW MAUNG
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 650-204-0133