Provider Demographics
NPI:1740598960
Name:CARBON HEALTH MEDICAL GROUP OF SUNNYVALE INC
Entity type:Organization
Organization Name:CARBON HEALTH MEDICAL GROUP OF SUNNYVALE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAITLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-601-5392
Mailing Address - Street 1:2100 FRANKLIN ST STE 355
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3140
Mailing Address - Country:US
Mailing Address - Phone:415-446-1733
Mailing Address - Fax:888-972-1912
Practice Address - Street 1:500 E REMINGTON DR
Practice Address - Street 2:SUITE 20
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-2657
Practice Address - Country:US
Practice Address - Phone:650-318-3384
Practice Address - Fax:650-230-4998
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARBON HEALTH MEDICAL GROUP OF SUNNYVALE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-22
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11338207RG0300X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFB723AMedicare PIN