Healthcare Provider Details

I. General information

NPI: 1093727463
Provider Name (Legal Business Name): PARNASSUS HEIGHTS PODIATRY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SHRADER ST STE 510 STE 4A
SAN FRANCISCO CA
94117-1034
US

IV. Provider business mailing address

1 SHRADER ST STE 510
SAN FRANCISCO CA
94117-1034
US

V. Phone/Fax

Practice location:
  • Phone: 415-759-2014
  • Fax: 415-759-2015
Mailing address:
  • Phone: 415-759-2014
  • Fax: 415-759-2015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberT10912
License Number StateCA

VIII. Authorized Official

Name: DR. JAMIE KIM
Title or Position: OFFICER
Credential: DPM
Phone: 415-759-2014