Healthcare Provider Details

I. General information

NPI: 1588279343
Provider Name (Legal Business Name): JAMES ROBERT POON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 ATLANTIC AVE
ALAMEDA CA
94501-2298
US

IV. Provider business mailing address

1216 CLAY ST APT 202
SAN FRANCISCO CA
94108-1477
US

V. Phone/Fax

Practice location:
  • Phone: 510-535-7363
  • Fax:
Mailing address:
  • Phone: 415-627-7907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60703
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: