Graduated: 1995
NPI: 1871777573
Practice Locations (2)
COUNTY OF SAN MATEO
222 W 39TH AVE
SAN MATEO, CA 944034364
6505732222
PERMANENTE MEDICAL GROUP INC
710 LAWRENCE EXPRESS WAY
SANTA CLARA, CA 950515173
4088511000
Source: CMS National Downloadable File, September 2026.