Healthcare Provider Details

I. General information

NPI: 1700412632
Provider Name (Legal Business Name): SOPHIA KARANDASHOVA MD, PHD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 12/11/2022
Certification Date: 12/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 16TH ST FL HALL4
SAN FRANCISCO CA
94143-2549
US

IV. Provider business mailing address

550 16TH ST FL HALL4
SAN FRANCISCO CA
94143-2549
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-5001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberPTL3596
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA183363
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: