Healthcare Provider Details

I. General information

NPI: 1245398577
Provider Name (Legal Business Name): KAISER SAN FRANCISCO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2245 GEARY STREET
SAN FRANCISCO CA
94115
US

IV. Provider business mailing address

62 INVERNESS DR
SAN RAFAEL CA
94901-2418
US

V. Phone/Fax

Practice location:
  • Phone: 415-833-2000
  • Fax:
Mailing address:
  • Phone: 415-457-4823
  • Fax: 415-457-4823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberB333360
License Number StateCA

VIII. Authorized Official

Name: MRS. DENISE SUZANNE JONES
Title or Position: PEDIATRIC NURSE PRACTITIONER
Credential: RN, MSN
Phone: 415-833-2000