Healthcare Provider Details

I. General information

NPI: 1962936054
Provider Name (Legal Business Name): UCSF MEDICAL GROUP BUSINESS SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2017
Last Update Date: 04/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 52ND ST
OAKLAND CA
94609-1810
US

IV. Provider business mailing address

3333 CALIFORNIA ST STE S-10
SAN FRANCISCO CA
94118-1981
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-1788
  • Fax: 415-476-7003
Mailing address:
  • Phone: 415-885-7268
  • Fax: 415-885-7445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. KOSAL BO
Title or Position: DIRECTOR, MEDICAL STAFF OFFICE
Credential:
Phone: 415-885-7268