Healthcare Provider Details

I. General information

NPI: 1710426754
Provider Name (Legal Business Name): LOIS KINCY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2017
Last Update Date: 02/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 3RD ST STE 610
SAN FRANCISCO CA
94124-1446
US

IV. Provider business mailing address

1263 EGBERT AVE
SAN FRANCISCO CA
94124-3636
US

V. Phone/Fax

Practice location:
  • Phone: 415-682-3256
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: