MEDICARE: JIRAYUT LATTHIVONGSKORN MD, MPH

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	207Q00000X	Family Medicine Physician	2950	CA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1508422403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIRAYUT LATTHIVONGSKORN MD, MPH

Provider Business Mailing Address
First Line	:	1 EMBARCADERO CTR STE 1900
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94111-3723
Country	:	US
Telephone Number	:	415-658-6791
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 ILLINOIS ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143-2501
Country	:	US
Telephone Number	:	415-353-9188
Fax Number	:	415-476-9655

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2019
Last Update Date	:	12/19/2025

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