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NPI Code Detail

MEDICARE: GRACE SI-WAH ENG MD

MEDICARE: GRACE SI-WAH ENG MD
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
1207R00000XInternal Medicine PhysicianA86467CA
2207RE0101XEndocrinology, Diabetes & Metabolism PhysicianA86467CA

General Provider Information

NPI Number : 1871552679
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE SI-WAH ENG MD
Provider Business Mailing Address
First Line : 5800 HOLLIS ST
Second Line :
City : EMERYVILLE
State : CA
Zip : 94608-2016
Country : US
Telephone Number : 510-806-2100
Fax Number : 510-806-2557
Provider Business Practice Location Address
First Line : 5800 HOLLIS ST
Second Line :
City : EMERYVILLE
State : CA
Zip : 94608-2016
Country : US
Telephone Number : 510-806-2100
Fax Number : 510-806-2557
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2006
Last Update Date : 04/29/2024

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