=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992668388
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JUDGE MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2025
-----------------------------------------------------
Last Update Date | 12/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1199 BUSH ST STE 490
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94109-5987
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-409-9760
-----------------------------------------------------
Fax | 415-358-1879
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2443 FILLMORE ST UNIT 380-7054
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94115-1814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-409-9760
-----------------------------------------------------
Fax | 415-358-1879
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | NAINA TANYA JUDGE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 415-409-9760
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0122X
-----------------------------------------------------
Taxonomy Name | Plastic and Reconstructive Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------