Healthcare Provider Details

I. General information

NPI: 1144270612
Provider Name (Legal Business Name): NIKOLAJ WOLFSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 SUTTER ST SUITE 207
SAN FRANCISCO CA
94115-3037
US

IV. Provider business mailing address

2300 SUTTER ST STE 207
SAN FRANCISCO CA
94115-3029
US

V. Phone/Fax

Practice location:
  • Phone: 415-221-4400
  • Fax: 415-798-2213
Mailing address:
  • Phone: 415-221-4400
  • Fax: 415-798-2213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number21346
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberC51436
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberC51436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: