Healthcare Provider Details

I. General information

NPI: 1629657424
Provider Name (Legal Business Name): SAN FRANCISCO SPINE SURGEONS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SHRADER ST STE 600
SAN FRANCISCO CA
94117-1018
US

IV. Provider business mailing address

1 SHRADER ST STE 600
SAN FRANCISCO CA
94117-1018
US

V. Phone/Fax

Practice location:
  • Phone: 415-750-5845
  • Fax: 415-750-8103
Mailing address:
  • Phone: 415-750-5845
  • Fax: 415-750-8103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: DIMITRIY KONDRASHOV
Title or Position: CEO
Credential: MD
Phone: 415-750-5845