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General NPI Number Information
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NPI Number | 1699858233
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Entity Type | Organization
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Legal Business Name | PENINSULA DERMATOLOGY MEDICAL GROUP INC
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 10/27/2014
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Provider Practice Location Address
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Address Line | 1750 EL CAMINO REAL STE 206
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City | BURLINGAME
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State | CA
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Zip | 94010
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Country | US
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Telephone | 650-692-0182
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Fax | 650-692-7741
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Provider Business Mailing Address
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Address Line | 1750 EL CAMINO REAL STE 206
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City | BURLINGAME
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State | CA
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Zip | 94010
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Country | US
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Telephone | 650-692-0182
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Fax | 650-692-7741
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DONALD M KAY
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Credential | M.D.
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Telephone | 650-692-0182
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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