=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780012807
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KATHLEEN HUM OD, A CALIFORNIA PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2013
-----------------------------------------------------
Last Update Date | 10/29/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 SUTTER ST STE 508
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94102-1114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-362-7707
-----------------------------------------------------
Fax | 415-362-9663
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 SUTTER ST STE 508
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94102-1114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-362-7707
-----------------------------------------------------
Fax | 415-362-9663
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. KATHLEEN HUM
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 415-362-7707
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | CA 8253T
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------