1861141426 NPI number — JUSTIN P MA MD

Table of content: JUSTIN P MA MD (NPI 1861141426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861141426 NPI number — JUSTIN P MA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MA
Provider First Name:
JUSTIN
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1861141426
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 POTRERO AVENUE
Provider Second Line Business Mailing Address:
BLDG. 5, 4TH FLOOR, SUITE 4M
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94110-3510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
628-206-4420
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
490 ILLINOIS STREET,
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-353-2020
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/21/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  A194699 , 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)





Copyright © 2007-2026 www.npivalidator.com