Healthcare Provider Details

I. General information

NPI: 1427837988
Provider Name (Legal Business Name): MR. KYLE THOMAS REMY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVENUE BUILDING 5, 6TH FLOOR, SUITE #6B10
SAN FRANCISCO CA
94110
US

IV. Provider business mailing address

1001 POTRERO AVENUE BUILDING 5, 6TH FLOOR, SUITE #6B
SAN FRANCISCO CA
94110
US

V. Phone/Fax

Practice location:
  • Phone: 628-206-4444
  • Fax: 628-206-3142
Mailing address:
  • Phone: 628-206-4444
  • Fax: 628-206-3142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: