Provider Demographics
NPI:1629560149
Name:NORCAL PEDIATRIC SURGICAL PARTNERS
Entity Type:Organization
Organization Name:NORCAL PEDIATRIC SURGICAL PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-862-1862
Mailing Address - Street 1:21C ORINDA WAY # 276
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-2534
Mailing Address - Country:US
Mailing Address - Phone:510-862-1862
Mailing Address - Fax:
Practice Address - Street 1:21C ORINDA WAY # 276
Practice Address - Street 2:
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-2534
Practice Address - Country:US
Practice Address - Phone:510-862-1862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA625762086S0120X
CAA6765702086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA62576Medicaid
CAA676570Medicaid