Healthcare Provider Details

I. General information

NPI: 1356538631
Provider Name (Legal Business Name): KATHRYN CHENIN KENIG NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE STE 3A16
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

1001 POTRERO AVE STE 3A16
SAN FRANCISCO CA
94110-3518
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-2557
  • Fax: 415-206-5153
Mailing address:
  • Phone: 415-206-2557
  • Fax: 415-206-5153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17060
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF3355121
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: