Healthcare Provider Details

I. General information

NPI: 1700793650
Provider Name (Legal Business Name): SOMA & PSYCHE FUNCTIONAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 BUSH ST STE 131D
SAN FRANCISCO CA
94109-5273
US

IV. Provider business mailing address

520 MIRAMAR AVE
SAN FRANCISCO CA
94112-1215
US

V. Phone/Fax

Practice location:
  • Phone: 415-952-6018
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL JACOB
Title or Position: CHIEF FINANCIAL OFFICER
Credential: MD, PHD
Phone: 510-847-6107