Healthcare Provider Details

I. General information

NPI: 1801380613
Provider Name (Legal Business Name): AUSTIN TAKEO MOMII MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 DUBOCE AVE # 165A
SAN FRANCISCO CA
94117-3389
US

IV. Provider business mailing address

68 GATES ST
SAN FRANCISCO CA
94110-5656
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-5555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberA166061
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA166061
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: