Provider Demographics
NPI:1275604183
Name:SAN MATEO DIALYSIS ASSOCIATES
Entity Type:Organization
Organization Name:SAN MATEO DIALYSIS ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:YEE HANG
Authorized Official - Last Name:LUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-692-6302
Mailing Address - Street 1:PO BOX 730
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-4022
Mailing Address - Country:US
Mailing Address - Phone:650-341-0725
Mailing Address - Fax:
Practice Address - Street 1:1750 EL CAMINO REAL
Practice Address - Street 2:15
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3208
Practice Address - Country:US
Practice Address - Phone:650-692-6302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44819207RN0300X
CAG60085207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty