Healthcare Provider Details

I. General information

NPI: 1902728504
Provider Name (Legal Business Name): HEARMON SEMERE KESETE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 EDMONDS RD
REDWOOD CITY CA
94062-3813
US

IV. Provider business mailing address

645 FOOTHILL BLVD APT 3
OAKLAND CA
94606-2451
US

V. Phone/Fax

Practice location:
  • Phone: 650-930-7491
  • Fax:
Mailing address:
  • Phone: 341-237-0627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-BVLFMN
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: