Healthcare Provider Details

I. General information

NPI: 1629788088
Provider Name (Legal Business Name): MIRIAM KEMPER JONES DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 BROADWAY
OAKLAND CA
94611-5730
US

IV. Provider business mailing address

1743 TICE VALLEY BLVD
WALNUT CREEK CA
94595-1632
US

V. Phone/Fax

Practice location:
  • Phone: 502-517-1644
  • Fax:
Mailing address:
  • Phone: 502-517-1644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number6232
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: