MEDICARE: KATHRYN ELIZABETH DERE MD

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	A191366	CA

General Provider Information

NPI Number	:	1588284624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN ELIZABETH DERE MD

Provider Business Mailing Address
First Line	:	1441 POWELL ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94133-3849
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1441 POWELL ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94133-3849
Country	:	US
Telephone Number	:	415-292-8888
Fax Number	:

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

Provider Enumeration Date	:	04/18/2020
Last Update Date	:	09/15/2024

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