Healthcare Provider Details

I. General information

NPI: 1720164239
Provider Name (Legal Business Name): GWENDOLYN C. OKUZUMI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CALIFORNIA ST STE 2300
SAN FRANCISCO CA
94111-5424
US

IV. Provider business mailing address

1 CALIFORNIA ST STE 2300
SAN FRANCISCO CA
94111-5424
US

V. Phone/Fax

Practice location:
  • Phone: 415-504-3838
  • Fax: 415-504-1367
Mailing address:
  • Phone: 415-504-3838
  • Fax: 415-504-1367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberT2033
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME147618
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-47866
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0065122
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-11656
License Number StateHI
# 6
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number307217
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number61744
License Number StateAZ
# 8
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA76974
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2020-1030
License Number StateNM
# 10
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number166659
License Number StateAK
# 11
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD201499
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: