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General NPI Number Information
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NPI Number | 1093903205
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Entity Type | Organization
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Legal Business Name | SOMA ORTHOPEDICS MEDICAL GROUP INC
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Dates
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Enumeration Date | 10/12/2007
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Last Update Date | 07/29/2022
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Provider Practice Location Address
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Address Line | 1580 VALENCIA ST SUITE 703
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City | SAN FRANCISCO
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State | CA
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Zip | 94110-4423
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Country | US
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Telephone | 415-642-0707
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Fax | 415-550-1566
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Provider Business Mailing Address
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Address Line | PO BOX 1230
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City | SUISUN CITY
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State | CA
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Zip | 94585-1230
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Country | US
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Telephone | 415-642-0707
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Fax | 415-550-1566
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVE ATKIN
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Credential | MD
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Telephone | 415-550-1474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | A79161
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | A90204
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | G65707
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License Number State | CA
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