Provider Demographics
NPI:1992983480
Name:SAN FRANCISCO-PENINSULA E N T ASSOCIATES A MEDICAL CORPORATION
Entity type:Organization
Organization Name:SAN FRANCISCO-PENINSULA E N T ASSOCIATES A MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:KMUCHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD JD
Authorized Official - Phone:925-254-6710
Mailing Address - Street 1:77 MORAGA WAY STE G
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-3019
Mailing Address - Country:US
Mailing Address - Phone:925-254-6710
Mailing Address - Fax:925-254-6713
Practice Address - Street 1:77 MORAGA WAY STE G
Practice Address - Street 2:
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-3019
Practice Address - Country:US
Practice Address - Phone:925-254-6710
Practice Address - Fax:925-254-6713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ42562ZMedicare PIN