Provider Demographics
NPI:1649367491
Name:WOO, RICHARD ACE (DPM)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ACE
Last Name:WOO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 708
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-0708
Mailing Address - Country:US
Mailing Address - Phone:650-347-0761
Mailing Address - Fax:650-343-1498
Practice Address - Street 1:1860 EL CAMINO REAL
Practice Address - Street 2:SUITE 207
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3127
Practice Address - Country:US
Practice Address - Phone:650-347-0761
Practice Address - Fax:650-343-1498
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2014-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3697213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E36970Medicaid
CA5337100001OtherDMERC NORIDIAN
CA000E36971Medicaid
CA000E36970Medicaid
CA5337100001OtherDMERC NORIDIAN
CA000E36971Medicaid