Healthcare Provider Details

I. General information

NPI: 1093365231
Provider Name (Legal Business Name): PRIVATE MEDICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 CALIFORNIA ST STE 101
SAN FRANCISCO CA
94118-1716
US

IV. Provider business mailing address

3580 CALIFORNIA ST STE 101
SAN FRANCISCO CA
94118-1716
US

V. Phone/Fax

Practice location:
  • Phone: 415-830-3090
  • Fax: 415-520-5191
Mailing address:
  • Phone: 415-830-3090
  • Fax: 415-504-3313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JORDAN L SHLAIN
Title or Position: CEO
Credential: MD
Phone: 415-830-3090