Healthcare Provider Details

I. General information

NPI: 1679657365
Provider Name (Legal Business Name): SALLY HAVNER KAUFMANN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 AVILA STREET
SAN FRANCISCO CA
94123-1106
US

IV. Provider business mailing address

324 AVILA STREET
SAN FRANCISCO CA
94123-1106
US

V. Phone/Fax

Practice location:
  • Phone: 415-567-3535
  • Fax: 415-567-1075
Mailing address:
  • Phone: 415-567-3535
  • Fax: 415-567-1075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG6425
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: