Healthcare Provider Details

I. General information

NPI: 1841405230
Provider Name (Legal Business Name): SAN FRANCSICO GENERAL HOSPITAL RENAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE BUILDING 100, ROOM 342
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

1001 POTRERO AVE BUILDING 100, ROOM 342
SAN FRANCISCO CA
94110-3518
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-4617
  • Fax: 415-282-8182
Mailing address:
  • Phone: 415-476-4617
  • Fax: 415-282-8182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License Number052397
License Number StateCA

VIII. Authorized Official

Name: MS. JEP POON
Title or Position: DIVISION ADMINISTRATOR
Credential:
Phone: 415-476-4617