MEDICARE: UCSF SFGH CLINICAL PRACTICE GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	MFC34098	CA

General Provider Information

NPI Number	:	1043365042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UCSF SFGH CLINICAL PRACTICE GROUP

Provider Business Mailing Address
First Line	:	1930 MARKET ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94102-6228
Country	:	US
Telephone Number	:	415-476-3598
Fax Number	:	415-476-3655

Provider Business Practice Location Address
First Line	:	1930 MARKET ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94102-6228
Country	:	US
Telephone Number	:	415-476-3598
Fax Number	:	415-476-3655

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. JAMES DILLEY
Credential	:	M.D.
Telephone Number	:	415-476-6442

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	08/22/2020

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