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General NPI Number Information
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NPI Number | 1346828340
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Entity Type | Individual
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Provider Name | SAMUEL LIAM THOMPSON
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Gender | Male
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Dates
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Enumeration Date | 03/31/2021
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 550 16TH ST FL 4 BOX 0110
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City | SAN FRANCISCO
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State | CA
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Zip | 94158-2604
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Country | US
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Telephone | 628-588-6362
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Fax |
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Provider Business Mailing Address
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Address Line | 550 16TH ST FL 4 BOX 0110
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City | SAN FRANCISCO
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State | CA
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Zip | 94158-2604
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Country | US
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Telephone | 628-588-6362
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD2024-0459
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | A201047
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License Number State | CA
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