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General NPI Number Information
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NPI Number | 1578833059
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Entity Type | Organization
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Legal Business Name | JSMD PC
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Dates
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Enumeration Date | 12/30/2011
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Last Update Date | 06/23/2016
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Provider Practice Location Address
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Address Line | 350 LORTON AVENUE
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City | BURLINGAME
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State | CA
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Zip | 94010-4104
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Country | US
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Telephone | 650-241-6508
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Fax | 925-482-1195
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Provider Business Mailing Address
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Address Line | PO BOX 117627
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City | BURLINGAME
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State | CA
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Zip | 94011-7627
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Country | US
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Telephone | 650-241-6508
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Fax | 925-482-1195
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Authorized Official
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Title or Position | CO-FOUNDER AND MEDICAL DIRECTOR
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Name | MR. SEAN E. BOURKE
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Credential | M.D.
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Telephone | 650-241-6508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QB0002X
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Taxonomy Name | Obesity Medicine (Family Medicine) Physician
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License Number | A66219
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207QB0002X
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Taxonomy Name | Obesity Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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