Healthcare Provider Details

I. General information

NPI: 1669082558
Provider Name (Legal Business Name): KRISTIN KIMBERLY MCDONALD GIBSON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN MCDONALD PHD

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 16TH ST
SAN FRANCISCO CA
94103-5110
US

IV. Provider business mailing address

1400 16TH ST
SAN FRANCISCO CA
94103-5110
US

V. Phone/Fax

Practice location:
  • Phone: 800-436-3037
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0203X
TaxonomyClinical Molecular Genetics Physician
License NumberDRN-02014583
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: