Provider Demographics
NPI:1053152165
Name:COMMUNITY PODIATRY SERVICE, INC.
Entity type:Organization
Organization Name:COMMUNITY PODIATRY SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GIAO
Authorized Official - Middle Name:
Authorized Official - Last Name:LUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:650-683-2073
Mailing Address - Street 1:1417 S CLAREMONT ST
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2118
Mailing Address - Country:US
Mailing Address - Phone:650-683-2073
Mailing Address - Fax:650-654-9054
Practice Address - Street 1:1417 S CLAREMONT ST
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2118
Practice Address - Country:US
Practice Address - Phone:650-683-2073
Practice Address - Fax:650-654-9054
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY PODIATRY SERVICE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty