Healthcare Provider Details

I. General information

NPI: 1699121905
Provider Name (Legal Business Name): LYNDLY JOHNNI TAMURA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 OWENS ST STE 170
SAN FRANCISCO CA
94158-2335
US

IV. Provider business mailing address

1500 OWENS ST STE 170
SAN FRANCISCO CA
94158-2335
US

V. Phone/Fax

Practice location:
  • Phone: 415-514-6828
  • Fax: 415-514-6165
Mailing address:
  • Phone: 415-514-6828
  • Fax: 415-514-6165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number302558
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA151149
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: