Provider Demographics
NPI:1699837120
Name:RUSSELL D WOO, M.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:RUSSELL D WOO, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:D
Authorized Official - Last Name:WOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-923-3004
Mailing Address - Street 1:2100 WEBSTER ST
Mailing Address - Street 2:SUITE 520
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2382
Mailing Address - Country:US
Mailing Address - Phone:415-923-3004
Mailing Address - Fax:415-982-0629
Practice Address - Street 1:2100 WEBSTER ST
Practice Address - Street 2:SUITE 520
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2382
Practice Address - Country:US
Practice Address - Phone:415-923-3004
Practice Address - Fax:415-982-0629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC33104174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8276517Medicaid
CAA35161Medicare UPIN
CA8276517Medicaid