Provider Demographics
NPI:1023037470
Name:SUNDBERG, RICHARD S (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:S
Last Name:SUNDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 CALIFORNIA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-4587
Mailing Address - Country:US
Mailing Address - Phone:415-387-8800
Mailing Address - Fax:415-387-5204
Practice Address - Street 1:1700 CALIFORNIA ST STE 100
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4587
Practice Address - Country:US
Practice Address - Phone:415-387-8800
Practice Address - Fax:415-387-5204
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG29935207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G299350Medicaid
CA00G299350Medicare ID - Type Unspecified
CAA44226Medicare UPIN