Provider Demographics
NPI:1982691119
Name:DHANAK, MICHELLE RUTH (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:RUTH
Last Name:DHANAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1633 OLD BAYSHORE HWY
Mailing Address - Street 2:SUTIE 245
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010
Mailing Address - Country:US
Mailing Address - Phone:650-357-8834
Mailing Address - Fax:650-357-8811
Practice Address - Street 1:1633 OLD BAYSHORE HWY
Practice Address - Street 2:SUITE 245
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010
Practice Address - Country:US
Practice Address - Phone:650-357-8834
Practice Address - Fax:650-357-8811
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG74482207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G744821Medicaid
CA00G744821Medicaid
CAF65984Medicare UPIN