Healthcare Provider Details

I. General information

NPI: 1013592393
Provider Name (Legal Business Name): KATHLEEN JORDAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 MISSION ST
SAN FRANCISCO CA
94103-2513
US

IV. Provider business mailing address

30 E 23RD ST STE 700
NEW YORK NY
10010-4408
US

V. Phone/Fax

Practice location:
  • Phone: 332-203-0933
  • Fax:
Mailing address:
  • Phone: 332-203-0933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. TOM BARNES
Title or Position: VP, PAYER STRATEGY & REVENUE CYCLE
Credential:
Phone: 973-943-0967