Healthcare Provider Details

I. General information

NPI: 1326943507
Provider Name (Legal Business Name): JAMIE KIMMEL BCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PARNASSUS AVE FL 7
SAN FRANCISCO CA
94143-2202
US

IV. Provider business mailing address

1880 CHURCH ST
SAN FRANCISCO CA
94131-2713
US

V. Phone/Fax

Practice location:
  • Phone: 415-629-1069
  • Fax:
Mailing address:
  • Phone: 415-680-5325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: