Provider Demographics
NPI:1619244837
Name:RICHARD A. SUNDBERG, M.D. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:RICHARD A. SUNDBERG, M.D. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SUNDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-387-8800
Mailing Address - Street 1:1700 CALIFORNIA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-4587
Mailing Address - Country:US
Mailing Address - Phone:415-387-8800
Mailing Address - Fax:415-387-5204
Practice Address - Street 1:1700 CALIFORNIA ST STE 100
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4587
Practice Address - Country:US
Practice Address - Phone:415-387-8800
Practice Address - Fax:415-387-5204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-17
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG29935207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty