Healthcare Provider Details

I. General information

NPI: 1326351446
Provider Name (Legal Business Name): MICHAEL CHINWEN KE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2010
Last Update Date: 03/07/2023
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 VAN NESS AVE
SAN FRANCISCO CA
94109-6978
US

IV. Provider business mailing address

1155 MILL ST # MCM14
RENO NV
89502-1576
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-5760
  • Fax: 415-369-1208
Mailing address:
  • Phone: 775-982-5262
  • Fax: 775-982-5496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number20541
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA118293
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number20541
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberA118293
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: