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Provider Information for 1144382227

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: MALE

Individual NPI: 1144382227

Calendar   Last Updated:  2010-03-04
  Certification Date: 


Name Value
NPI 1144382227
Enumeration Date 2006-12-14
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 400 LIVE OAK WAY 402
BELMONT, CA 94002-7249
United States

Phone: 650-468-7516 | Fax:
View Map External Link
Primary Practice Address 1001 POTRERO AVE BLD 80
SAN FRANCISCO, CA 94110-3518
United States

Phone: 415-206-8053 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 261QC1500X - Clinic/Center Community Health CA CA17411