Provider Demographics
NPI:1912915778
Name:LICHTI, RICHARD JOHNSTON JR (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JOHNSTON
Last Name:LICHTI
Suffix:JR
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 1:6805 FIVE STAR BLVD
Mailing Address - Street 2:100
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-2684
Mailing Address - Country:US
Mailing Address - Phone:916-624-3500
Mailing Address - Fax:916-624-3351
Practice Address - Street 1:6805 FIVE STAR BLVD
Practice Address - Street 2:100
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2684
Practice Address - Country:US
Practice Address - Phone:916-624-3500
Practice Address - Fax:916-624-3351
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83419207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ26454ZOtherMEDICARE GROUP PTAN
H64675Medicare UPIN
CAZZZ26454ZOtherMEDICARE GROUP PTAN