Healthcare Provider Details

I. General information

NPI: 1669596482
Provider Name (Legal Business Name): GENE A NAKAJIMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 12/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 OCEAN AVE
SAN FRANCISCO CA
94112-1727
US

IV. Provider business mailing address

1701 OCEAN AVE
SAN FRANCISCO CA
94112-1727
US

V. Phone/Fax

Practice location:
  • Phone: 415-452-2200
  • Fax: 415-334-5712
Mailing address:
  • Phone: 415-452-2200
  • Fax: 415-334-5712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA52002
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: