Healthcare Provider Details

I. General information

NPI: 1285900910
Provider Name (Legal Business Name): JONATHAN HAYNES ESENSTEN M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 BERRY ST STE 100 C/O KIRSTEN DAHMEN
SAN FRANCISCO CA
94107-1758
US

IV. Provider business mailing address

513 PARNASSUS AVE HSE 711
SAN FRANCISCO CA
94143
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-7359
  • Fax: 415-514-8928
Mailing address:
  • Phone: 415-502-3785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License NumberA128404
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: