Provider Demographics
NPI:1508810763
Name:RYDFORS, JAN TODD (MD)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:TODD
Last Name:RYDFORS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 PRICE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1433
Mailing Address - Country:US
Mailing Address - Phone:650-701-1882
Mailing Address - Fax:650-365-9782
Practice Address - Street 1:570 PRICE AVE STE 100
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1433
Practice Address - Country:US
Practice Address - Phone:650-701-1882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65169207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G651690Medicaid
CA00G651690Medicaid