Healthcare Provider Details

I. General information

NPI: 1417764598
Provider Name (Legal Business Name): JULIEN VAILLANCOURT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 PARNASSUS AVE
SAN FRANCISCO CA
94143
US

IV. Provider business mailing address

5720 UPPER-LACHINE ROAD, APT #421
MONTREAL QUEBEC
H4A2B2
CA

V. Phone/Fax

Practice location:
  • Phone: 415-476-1000
  • 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: