Healthcare Provider Details

I. General information

NPI: 1083199541
Provider Name (Legal Business Name): YELDAR ZHURGENOV MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 HYDE ST
SAN FRANCISCO CA
94102-3386
US

IV. Provider business mailing address

240 HYDE ST
SAN FRANCISCO CA
94102-3386
US

V. Phone/Fax

Practice location:
  • Phone: 415-775-6006
  • Fax: 415-474-9518
Mailing address:
  • Phone: 415-775-6006
  • Fax: 415-474-9518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT152550
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: