1063044337 NPI number — DR. KIRSTEEN RENNIE BURTON M.D.

Table of content: DR. KIRSTEEN RENNIE BURTON M.D. (NPI 1063044337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063044337 NPI number — DR. KIRSTEEN RENNIE BURTON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURTON
Provider First Name:
KIRSTEEN
Provider Middle Name:
RENNIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1063044337
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
12/08/2020
NPI Reactivation Date:
02/23/2021

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 ST. CLAIR AVENUE WEST, SUITE 1605
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TORONTO
Provider Business Mailing Address State Name:
ONTARIO
Provider Business Mailing Address Postal Code:
M4V1N5
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UCSF DEPT. OF RADIOLOGY & BIOMEDICAL IMAGING
Provider Second Line Business Practice Location Address:
513 PARNASSUS AVENUE
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90103-0028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-476-1575
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/05/2020

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: 390200000X , with the licence number:  137416 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X , with the licence number: A158430 , 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)