1205180916 NPI number — CHINATOWN PUBLIC HEALTH CENTER

Table of content: KELLY DAVID GAGE M.D. (NPI 1356324370)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205180916 NPI number — CHINATOWN PUBLIC HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHINATOWN PUBLIC HEALTH CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205180916
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1490 MASON ST
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94133-4222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-364-7600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1490 MASON ST
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94133-4222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-364-7600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/01/2012

Additional Information

Authorized Official

Authorized Official Last Name:
YU
Authorized Official First Name:
ALBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL CENTER DIRECTOR
Authorized Official Telephone Number:
415-364-7600

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , with the licence number:  171M0000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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