Healthcare Provider Details

I. General information

NPI: 1205751427
Provider Name (Legal Business Name): MR. DARRYN GREEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 FOLSOM ST STE 702
SAN FRANCISCO CA
94107-4502
US

IV. Provider business mailing address

737 BAKER ST
SAN FRANCISCO CA
94115-4304
US

V. Phone/Fax

Practice location:
  • Phone: 415-715-1050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: