MEDICARE: DR. DINAH M BUKOWSKI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	393126	CA
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	393126	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	393126	OTHER	CA	AMERICAN BOARD OF INTERNAL MEDICINE
2	C55517	OTHER	CA	STATE MEDICAL LICENSE

General Provider Information

NPI Number	:	1639261530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DINAH M BUKOWSKI M.D.

Provider Business Mailing Address
First Line	:	325 DISTEL CIR
Second Line	:
City	:	LOS ALTOS
State	:	CA
Zip	:	94022-1408
Country	:	US
Telephone Number	:	415-600-7618
Fax Number	:	415-600-7625

Provider Business Practice Location Address
First Line	:	1375 SUTTER ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-5438
Country	:	US
Telephone Number	:	415-600-7618
Fax Number	:	415-600-7625

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	06/03/2020

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