Healthcare Provider Details

I. General information

NPI: 1215460753
Provider Name (Legal Business Name): HARISH VASUDEVAN MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE # L08
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

2351 CLAY ST SUITE 380
SAN FRANCISCO CA
94115-1931
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-7175
  • Fax:
Mailing address:
  • Phone: 415-600-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberA161578
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: