Healthcare Provider Details

I. General information

NPI: 1861141426
Provider Name (Legal Business Name): JUSTIN P MA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 ILLINOIS STREET,
SAN FRANCISCO CA
94158
US

IV. Provider business mailing address

1001 POTRERO AVENUE BLDG. 5, 4TH FLOOR, SUITE 4M
SAN FRANCISCO CA
94110-3510
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2020
  • Fax:
Mailing address:
  • Phone: 628-206-4420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA194699
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: