Provider Demographics
NPI:1407827959
Name:STEIN, ANDREW J (MD)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:J
Last Name:STEIN
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 1:13690 E 14TH ST
Mailing Address - Street 2:SUITE # 200
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2582
Mailing Address - Country:US
Mailing Address - Phone:510-297-0550
Mailing Address - Fax:510-297-0558
Practice Address - Street 1:13690 E 14TH ST
Practice Address - Street 2:SUITE # 200
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2582
Practice Address - Country:US
Practice Address - Phone:510-297-0550
Practice Address - Fax:510-297-0558
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75352174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC1941OtherRAILROAD MEDICARE PROVIDE
CA00G753520OtherBLUECROSS PROVIDER #
CA4299430001OtherCIGNA MEDICARE PROVIDER #
CAZZZ04834ZOtherBLUESHIELD PROVIDER #
CA00G753520OtherPROVIDER TRANSACTION ACCESS NUMBER
CA4299430001OtherCIGNA MEDICARE PROVIDER #