Provider Demographics
NPI:1003118290
Name:UROLOGICAL SURGEONS OF NORTHERN CALIFORNIA
Entity Type:Organization
Organization Name:UROLOGICAL SURGEONS OF NORTHERN CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:HC
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-866-2500
Mailing Address - Street 1:PO BOX 6971
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-0971
Mailing Address - Country:US
Mailing Address - Phone:402-486-7006
Mailing Address - Fax:
Practice Address - Street 1:123 DI SALVO AVE
Practice Address - Street 2:SUITE D
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1717
Practice Address - Country:US
Practice Address - Phone:408-294-9000
Practice Address - Fax:408-294-9004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-22
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6493340006Medicare NSC