Healthcare Provider Details

I. General information

NPI: 1578443859
Provider Name (Legal Business Name): JOHN ALEXANDER HUSTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 CLEMENT ST
SAN FRANCISCO CA
94118-2206
US

IV. Provider business mailing address

601 CLEMENT ST
SAN FRANCISCO CA
94118-2206
US

V. Phone/Fax

Practice location:
  • Phone: 415-668-5955
  • Fax:
Mailing address:
  • Phone: 628-219-9929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-ETHFVL
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: