Healthcare Provider Details

I. General information

NPI: 1649664566
Provider Name (Legal Business Name): ANDREW DALE KERKHOFF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2015
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE RM. 987
SAN FRANCISCO CA
94143-0119
US

IV. Provider business mailing address

505 PARNASSUS AVE RM. 987
SAN FRANCISCO CA
94143-0119
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-1528
  • Fax: 415-502-1976
Mailing address:
  • Phone: 415-476-1528
  • Fax: 415-502-1976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA145809
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA145809
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: