Healthcare Provider Details

I. General information

NPI: 1912345539
Provider Name (Legal Business Name): BAYVIEW HUNTERS POINT FOUNDATION FOR COMMUNITY IMPROVEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2013
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5815 3RD ST
SAN FRANCISCO CA
94124-3101
US

IV. Provider business mailing address

5815 3RD ST
SAN FRANCISCO CA
94124-3101
US

V. Phone/Fax

Practice location:
  • Phone: 415-468-5100
  • Fax: 415-468-5104
Mailing address:
  • Phone: 415-468-5100
  • Fax: 415-468-5104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN265461
License Number StateCA

VIII. Authorized Official

Name: SHARAM KOHAN
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 415-468-5100