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General NPI Number Information
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NPI Number | 1710531959
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Entity Type | Individual
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Provider Name | JAKE KOCH
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Gender | Male
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Dates
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Enumeration Date | 07/25/2019
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Last Update Date | 12/29/2021
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Provider Practice Location Address
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Address Line | 3401 TARAVAL ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94116-2050
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Country | US
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Telephone | 415-682-9902
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Fax |
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Provider Business Mailing Address
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Address Line | 2825 RIVERA ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94116-1660
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 295250
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License Number State | CA
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