Provider Demographics
NPI:1568455152
Name:RANDALL A. ICHIHANA
Entity Type:Organization
Organization Name:RANDALL A. ICHIHANA
Other - Org Name:MARIN PULMONARY SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:AKIRA
Authorized Official - Last Name:ICHIHANA
Authorized Official - Suffix:
Authorized Official - Credentials:RCP , RPFT
Authorized Official - Phone:415-925-1626
Mailing Address - Street 1:PO BOX 11201
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94912-1201
Mailing Address - Country:US
Mailing Address - Phone:415-925-1626
Mailing Address - Fax:415-925-1826
Practice Address - Street 1:1050 NORTHGATE DR
Practice Address - Street 2:SUITE 250 A
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2526
Practice Address - Country:US
Practice Address - Phone:415-925-1626
Practice Address - Fax:415-925-1826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-29
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ16052ZMedicare ID - Type Unspecified