Healthcare Provider Details

I. General information

NPI: 1275490351
Provider Name (Legal Business Name): KIRK WHITELAW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 12TH AVE
SAN FRANCISCO CA
94118-2103
US

IV. Provider business mailing address

619 38TH AVE
SAN FRANCISCO CA
94121-2617
US

V. Phone/Fax

Practice location:
  • Phone: 415-750-8525
  • Fax:
Mailing address:
  • Phone: 248-909-0415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number220119698
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: