Provider Demographics
NPI:1003993247
Name:JAMES Y.GREENBERG, MD, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JAMES Y.GREENBERG, MD, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:YAKOV
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-474-7955
Mailing Address - Street 1:1730 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-4538
Mailing Address - Country:US
Mailing Address - Phone:415-474-7955
Mailing Address - Fax:415-292-0718
Practice Address - Street 1:2299 POST ST STE 205
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3473
Practice Address - Country:US
Practice Address - Phone:415-474-7955
Practice Address - Fax:415-292-0718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55519207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A555192Medicaid
CAG47501Medicare UPIN
CA00A555192Medicaid