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General NPI Number Information
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NPI Number | 1588024442
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Entity Type | Organization
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Legal Business Name | STANFORD EMPLOYER HEALTH CLINICS
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Dates
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Enumeration Date | 03/03/2016
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Last Update Date | 03/03/2016
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Provider Practice Location Address
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Address Line | 5535 MOREHOUSE DR BLDG S SUITE 270
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City | SAN DIEGO
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State | CA
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Zip | 92121-1710
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Country | US
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Telephone | 650-721-3099
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Fax | 650-725-2480
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Provider Business Mailing Address
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Address Line | 211 QUARRY RD
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City | PALO ALTO
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State | CA
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Zip | 94304-1416
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Country | US
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Telephone | 605-721-3099
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Fax | 650-725-2480
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Authorized Official
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Title or Position | LEAD PHYSICIAN
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Name | KWI BULOW
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Credential | MD
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Telephone | 650-721-3099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | G566674
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License Number State | CA
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