Healthcare Provider Details

I. General information

NPI: 1194375295
Provider Name (Legal Business Name): BERKELEY FOOT AND ANKLE PODIATRY GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 COLBY ST STE 104
BERKELEY CA
94705-2090
US

IV. Provider business mailing address

3000 COLBY ST STE 104
BERKELEY CA
94705-2090
US

V. Phone/Fax

Practice location:
  • Phone: 510-849-3800
  • Fax: 510-849-3810
Mailing address:
  • Phone: 510-849-3800
  • Fax: 510-849-3810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHAN KENNETH HUEY
Title or Position: PRESIDENT
Credential: DPM
Phone: 510-849-3800