MEDICARE: DR. LINCOLN SISON SISON 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	207R00000X	Internal Medicine Physician	D0078844	MD
2	207R00000X	Internal Medicine Physician	A152589	CA

General Provider Information

NPI Number	:	1982990370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINCOLN SISON SISON M.D.

Provider Business Mailing Address
First Line	:	1850 FAIRWAY DR
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94577-5629
Country	:	US
Telephone Number	:	510-746-0510
Fax Number	:

Provider Business Practice Location Address
First Line	:	1850 FAIRWAY DR
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94577-5629
Country	:	US
Telephone Number	:	510-746-0510
Fax Number	:

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

Provider Enumeration Date	:	06/23/2011
Last Update Date	:	04/22/2020

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