Healthcare Provider Details

I. General information

NPI: 1891889341
Provider Name (Legal Business Name): JOHN EDWARD MENDELSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 HYDE ST 210
SAN FRANCISCO CA
94109-4822
US

IV. Provider business mailing address

909 HYDE ST 210
SAN FRANCISCO CA
94109-4822
US

V. Phone/Fax

Practice location:
  • Phone: 415-474-7900
  • Fax: 415-474-7930
Mailing address:
  • Phone: 415-474-7900
  • Fax: 415-474-7930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG49959
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberG49959
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: