Provider Demographics
NPI:1134342215
Name:PENINSULA HEAD & NECK SURGERY,INC
Entity type:Organization
Organization Name:PENINSULA HEAD & NECK SURGERY,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:W
Authorized Official - Last Name:LIPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-329-9100
Mailing Address - Street 1:900 WELCH RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1805
Mailing Address - Country:US
Mailing Address - Phone:650-329-9100
Mailing Address - Fax:650-329-0626
Practice Address - Street 1:900 WELCH RD
Practice Address - Street 2:SUITE 103
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1805
Practice Address - Country:US
Practice Address - Phone:650-329-9100
Practice Address - Fax:650-329-0626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG124240207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEC455AMedicare PIN