Healthcare Provider Details

I. General information

NPI: 1598634214
Provider Name (Legal Business Name): DR. JAKE LEVY
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2025
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 NELSON RISING LN STE 190
SAN FRANCISCO CA
94143-0003
US

IV. Provider business mailing address

675 NELSON RISING LN STE 190
SAN FRANCISCO CA
94143-0003
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2057
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberA205739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: