Provider Demographics
NPI:1629006846
Name:OMACHI, THEODORE A (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:A
Last Name:OMACHI
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 1:3333 CALIFORNIA STREET
Mailing Address - Street 2:UNIVERSITY OF CALIFORNIA SAN FRANCISCO, SUITE 270
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1944
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:415-814-5770
Practice Address - Street 1:3333 CALIFORNIA ST
Practice Address - Street 2:UCSF, SUITE 270
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1981
Practice Address - Country:US
Practice Address - Phone:475-476-6926
Practice Address - Fax:415-814-5770
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87142207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI16252Medicare UPIN