Healthcare Provider Details

I. General information

NPI: 1437607983
Provider Name (Legal Business Name): LESLIE JOHN KILEY-SMITH RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 07/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 MARKET ST
SAN FRANCISCO CA
94103
US

IV. Provider business mailing address

163A NOE ST
SAN FRANCISCO CA
94114-1207
US

V. Phone/Fax

Practice location:
  • Phone: 415-863-3883
  • Fax: 415-863-7343
Mailing address:
  • Phone: 415-235-8172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number469122
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number469122
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number469122
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: