Provider Demographics
NPI:1063690352
Name:BURLINGAME ORTHOPEDICS AND SPORTS MEDICINE ASSOCIATES INC
Entity type:Organization
Organization Name:BURLINGAME ORTHOPEDICS AND SPORTS MEDICINE ASSOCIATES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-346-1114
Mailing Address - Street 1:1838 EL CAMINO REAL STE 100
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3105
Mailing Address - Country:US
Mailing Address - Phone:650-692-1475
Mailing Address - Fax:650-692-1643
Practice Address - Street 1:1838 EL CAMINO REAL STE 100
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3105
Practice Address - Country:US
Practice Address - Phone:650-692-1475
Practice Address - Fax:650-692-1643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP33329207X00000X
207X00000X
CAG65076207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ23265ZMedicaid
CAZZZ23265ZMedicaid
CAZZZ23265ZMedicare PIN