Provider Demographics
NPI:1568578474
Name:BALSTER, LOIS SHIOW (MD)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:SHIOW
Last Name:BALSTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:50 S SAN MATEO DR
Mailing Address - Street 2:STE 260
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3857
Mailing Address - Country:US
Mailing Address - Phone:650-579-6500
Mailing Address - Fax:650-579-1943
Practice Address - Street 1:50 S SAN MATEO DR
Practice Address - Street 2:STE 260
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3857
Practice Address - Country:US
Practice Address - Phone:650-579-6500
Practice Address - Fax:650-579-1943
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2022-01-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA90747208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H73604Medicare UPIN