MEDICARE: DR. PREBEN BRANDENHOFF M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	A81697	CA

General Provider Information

NPI Number	:	1104923879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PREBEN BRANDENHOFF M.D.

Provider Business Mailing Address
First Line	:	1950 CLAY ST
Second Line	:	SUITE 401
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-3479
Country	:	US
Telephone Number	:	415-823-1954
Fax Number	:	415-359-1954

Provider Business Practice Location Address
First Line	:	1950 CLAY ST
Second Line	:	401
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-3479
Country	:	US
Telephone Number	:	415-823-1954
Fax Number	:	415-359-1954

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	01/02/2014

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