Provider Demographics
NPI:1699911214
Name:DARYL HOFFMAN RECONSTRUCTIVE
Entity type:Organization
Organization Name:DARYL HOFFMAN RECONSTRUCTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:KRISTAN
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-325-1118
Mailing Address - Street 1:805 EL CAMINO REAL
Mailing Address - Street 2:SUITE A
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2315
Mailing Address - Country:US
Mailing Address - Phone:650-325-1118
Mailing Address - Fax:650-325-5778
Practice Address - Street 1:805 EL CAMINO REAL
Practice Address - Street 2:SUITE A
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2315
Practice Address - Country:US
Practice Address - Phone:650-325-1118
Practice Address - Fax:650-321-8943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-02
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG059181208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG059181OtherMEDICAL LICENSE
CA00G591811OtherBCBS
CA00G591810Medicare PIN
CA00G591811OtherBCBS