Provider Demographics
NPI:1073808168
Name:SANJORJO, JOSEPHUS-IAN LUMONGSUD (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPHUS-IAN
Middle Name:LUMONGSUD
Last Name:SANJORJO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSEPHUS-IAN
Other - Middle Name:LUMONGSUD
Other - Last Name:SANJORJO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1800 SULLIVAN AVE
Mailing Address - Street 2:SUITE 507
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2228
Mailing Address - Country:US
Mailing Address - Phone:650-817-7188
Mailing Address - Fax:650-513-8788
Practice Address - Street 1:1800 SULLIVAN AVE
Practice Address - Street 2:SUITE 507
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2228
Practice Address - Country:US
Practice Address - Phone:650-817-7188
Practice Address - Fax:650-513-8788
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2015-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA117377207R00000X, 207RN0300X, 208M00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
H26222966OtherPTAN
12257286OtherCAQH