Provider Demographics
NPI:1619687795
Name:PENINSULA MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:PENINSULA MEDICAL ASSOCIATES
Other - Org Name:ZAW MAUNG MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZAW
Authorized Official - Middle Name:
Authorized Official - Last Name:MAUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-204-0133
Mailing Address - Street 1:215 N SAN MATEO DR STE 10
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2674
Mailing Address - Country:US
Mailing Address - Phone:650-666-3644
Mailing Address - Fax:650-889-4036
Practice Address - Street 1:215 N SAN MATEO DR STE 10
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2674
Practice Address - Country:US
Practice Address - Phone:650-666-3644
Practice Address - Fax:650-889-4036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-30
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction MedicineGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty