Healthcare Provider Details

I. General information

NPI: 1063513570
Provider Name (Legal Business Name): FATIMAH OMAR JAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FATIMAH OMAR SILLAH MD

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MISSION ST STE 800
SAN FRANCISCO CA
94105-1744
US

IV. Provider business mailing address

101 MISSION ST STE 800
SAN FRANCISCO CA
94105-1744
US

V. Phone/Fax

Practice location:
  • Phone: 800-221-5140
  • Fax: 415-231-5332
Mailing address:
  • Phone: 800-221-5140
  • Fax: 415-231-5332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD 28985
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: