Provider Demographics
NPI:1639261530
Name:BUKOWSKI, DINAH M (MD)
Entity Type:Individual
Prefix:DR
First Name:DINAH
Middle Name:M
Last Name:BUKOWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:415-600-7618
Mailing Address - Fax:415-600-7625
Practice Address - Street 1:1375 SUTTER ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5438
Practice Address - Country:US
Practice Address - Phone:415-600-7618
Practice Address - Fax:415-600-7625
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA393126207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA393126OtherAMERICAN BOARD OF INTERNAL MEDICINE
CAC55517OtherSTATE MEDICAL LICENSE
HIH56107Medicare ID - Type Unspecified
HI541111Medicaid