Provider Demographics
NPI:1447280813
Name:ERLICH, KIM S (MD)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:S
Last Name:ERLICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2001 WINWARD WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94404-2499
Mailing Address - Country:US
Mailing Address - Phone:650-288-0597
Mailing Address - Fax:650-685-8043
Practice Address - Street 1:1501 TROUSDALE DR
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4506
Practice Address - Country:US
Practice Address - Phone:650-678-5079
Practice Address - Fax:650-969-5777
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52407207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G524070Medicaid
CAA52251Medicare UPIN
CA00G524070Medicaid