Healthcare Provider Details

I. General information

NPI: 1013080167
Provider Name (Legal Business Name): VINO K PALLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CYRIL MAGNIN ST UNIT 602
SAN FRANCISCO CA
94102-2871
US

IV. Provider business mailing address

10 CYRIL MAGNIN ST UNIT 602
SAN FRANCISCO CA
94102-2871
US

V. Phone/Fax

Practice location:
  • Phone: 773-220-8466
  • Fax:
Mailing address:
  • Phone: 773-220-8466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC52495
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number253328
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: