Healthcare Provider Details

I. General information

NPI: 1841528437
Provider Name (Legal Business Name): THANJIRA JIRANANTAKAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2009
Last Update Date: 11/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2789 25TH ST SUITE 2022
SAN FRANCISCO CA
94110-3582
US

IV. Provider business mailing address

1359 4TH AVE
SAN FRANCISCO CA
94122
US

V. Phone/Fax

Practice location:
  • Phone: 415-533-1995
  • Fax:
Mailing address:
  • Phone: 415-533-1995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083T0002X
TaxonomyMedical Toxicology (Preventive Medicine) Physician
License Number230577
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: