Healthcare Provider Details

I. General information

NPI: 1255794814
Provider Name (Legal Business Name): KATHLEEN DORA BONSMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN DORA BONGIOVANNI MD

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 4TH ST
SAN FRANCISCO CA
94143-2351
US

IV. Provider business mailing address

4800 SAND POINT WAY NE OC.7.830
SEATTLE WA
98105-3901
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA174817
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberML60657126
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA174817
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD.60960069
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: