Provider Demographics
NPI:1720157167
Name:RONALD K. L. SZETO M.D. A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:RONALD K. L. SZETO M.D. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:K
Authorized Official - Last Name:SZETO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-835-7687
Mailing Address - Street 1:3100 TELEGRAPH AVE
Mailing Address - Street 2:SUITE 4103
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3210
Mailing Address - Country:US
Mailing Address - Phone:510-835-7687
Mailing Address - Fax:510-835-1140
Practice Address - Street 1:3100 TELEGRAPH AVE
Practice Address - Street 2:SUITE 4103
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3210
Practice Address - Country:US
Practice Address - Phone:510-835-7687
Practice Address - Fax:510-835-1140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32468207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G324681Medicaid
CA00G324680Medicaid
060009964OtherUNITED HEALTHCARE
00G324680Medicare PIN
060009964OtherUNITED HEALTHCARE
CA00G324681Medicaid