Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | G29935 | CA |
NPI | 1023037470 |
---|---|
Provider Name | Dr. Richard S Sundberg |
First Address | San Francisco, CA 94109-4587 |
Second Address | San Francisco, CA 94109-4587 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 12/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G299350 | (05) | CA |
A44226 | (02) | CA |