Healthcare Provider Details

I. General information

NPI: 1548096977
Provider Name (Legal Business Name): KIM NEWELL GREEN M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2193 FILLMORE ST # 35
SAN FRANCISCO CA
94115-2223
US

IV. Provider business mailing address

530 DIVISADERO ST STE 108
SAN FRANCISCO CA
94117-2213
US

V. Phone/Fax

Practice location:
  • Phone: 415-496-5578
  • Fax:
Mailing address:
  • Phone: 415-496-5578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY NEWELL GREEN
Title or Position: OWNER
Credential: MD
Phone: 415-496-5578