Healthcare Provider Details

I. General information

NPI: 1093887630
Provider Name (Legal Business Name): UCSF MEDICAL GROUP BUSINESS SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 DIVISADERO ST
SAN FRANCISCO CA
94143-0001
US

IV. Provider business mailing address

1635 DIVISADERO ST SUITE 625, BOX 1821
SAN FRANCISCO CA
94143-0001
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-7720
  • Fax: 415-353-7358
Mailing address:
  • Phone: 415-476-4029
  • Fax: 415-476-4150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number220000091
License Number StateCA

VIII. Authorized Official

Name: MR. JED SHIVERS
Title or Position: COO
Credential:
Phone: 415-476-4003