Healthcare Provider Details

I. General information

NPI: 1003201237
Provider Name (Legal Business Name): JAYME CONGDON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAYME MULKEY MD

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 01/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 OWENS ST
SAN FRANCISCO CA
94158
US

IV. Provider business mailing address

3333 CALIFORNIA ST STE 245
SAN FRANCISCO CA
94118-6210
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-1000
  • Fax:
Mailing address:
  • Phone: 415-476-8273
  • Fax: 415-476-6106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA143766
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: