| Peninsula Gastrointestinal | |
|
100 S Ellsworth Ave Suite 507 San Mateo CA 94401-3939 | |
| (650) 342-7432 | |
| (650) 342-3239 |
| Full Name | Peninsula Gastrointestinal |
|---|---|
| Speciality | Internal Medicine |
| Location | 100 S Ellsworth Ave, San Mateo, California |
| Authorized Official Name and Position | Edward K Onuma (PRESIDENT) |
| Authorized Official Contact | 6503427432 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Peninsula Gastrointestinal 100 S Ellsworth Ave Suite 507 San Mateo CA 94401-3939 Ph: (650) 342-7432 | Peninsula Gastrointestinal 100 S Ellsworth Ave Suite 507 San Mateo CA 94401-3939 Ph: (650) 342-7432 |
| NPI Number | 1306144209 |
|---|---|
| Provider Enumeration Date | 03/02/2011 |
| Last Update Date | 08/18/2016 |
| Medicare PECOS PAC ID | 6204011471 |
|---|---|
| Medicare Enrollment ID | O20110503000655 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306144209 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
| Provider Name | Eugene Young Lee |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1023049590 PECOS PAC ID: 2163402603 Enrollment ID: I20040723000882 |
| Provider Name | Edward Onuma |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1477559722 PECOS PAC ID: 6103829387 Enrollment ID: I20110215000946 |
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