Healthcare Provider Details

I. General information

NPI: 1083017669
Provider Name (Legal Business Name): SF SPINE GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2014
Last Update Date: 09/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SHRADER ST STE 450
SAN FRANCISCO CA
94117-1016
US

IV. Provider business mailing address

1 SHRADER ST STE 450
SAN FRANCISCO CA
94117-1016
US

V. Phone/Fax

Practice location:
  • Phone: 415-750-5847
  • Fax:
Mailing address:
  • Phone: 415-750-5847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberA92439
License Number StateCA

VIII. Authorized Official

Name: DIMITRIY KONDRASHOV
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 415-750-5847