1730268657 NPI number — UCSF SFGH MAXILLO FACIAL SURGERY CL. #20-4

Table of content: (NPI 1730268657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730268657 NPI number — UCSF SFGH MAXILLO FACIAL SURGERY CL. #20-4

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UCSF SFGH MAXILLO FACIAL SURGERY CL. #20-4
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:
6
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:
1730268657
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 POTRERO AVE
Provider Second Line Business Mailing Address:
ROOM 1N1
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94110-3518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-206-6128
Provider Business Mailing Address Fax Number:
415-502-0817

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 POTRERO AVE
Provider Second Line Business Practice Location Address:
ROOM 1N1
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94110-3518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-206-6128
Provider Business Practice Location Address Fax Number:
415-502-0817
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FEATHERSTONE
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
INTERIM DEAN
Authorized Official Telephone Number:
415-476-8997

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 204E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: GR0041991 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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