Healthcare Provider Details

I. General information

NPI: 1619674504
Provider Name (Legal Business Name): KRISTEN FAVEL MD, MPH, FRCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2023
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 4TH ST FL 6
SAN FRANCISCO CA
94143-2350
US

IV. Provider business mailing address

550 16TH STREET MISSION HALL 4TH FLOOR
SAN FRANCISCO CA
94158-3214
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-2423
  • Fax:
Mailing address:
  • Phone: 415-476-2423
  • Fax: 415-476-9976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberA184179
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: