Provider Demographics
NPI:1790887974
Name:NORTHBAY PODIATRIC MEDICAL GRP INC
Entity Type:Organization
Organization Name:NORTHBAY PODIATRIC MEDICAL GRP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CHOY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:415-981-8828
Mailing Address - Street 1:728 PACIFIC AVE STE 502
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-4449
Mailing Address - Country:US
Mailing Address - Phone:415-981-8828
Mailing Address - Fax:415-981-7002
Practice Address - Street 1:728 PACIFIC AVE STE 502
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-4449
Practice Address - Country:US
Practice Address - Phone:415-981-8828
Practice Address - Fax:415-981-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3203213E00000X, 332B00000X
CAE4726213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05427ZOtherBLUE SHIELD OF CA
CAZZZ05428ZOtherBLUE SHIELD OF CA
CAZZZ05808ZMedicare PIN
CA4794430001Medicare NSC