Provider Demographics
NPI:1073630406
Name:PACIFIC HEMATOLOGY ONCOLOGY ASSOC
Entity Type:Organization
Organization Name:PACIFIC HEMATOLOGY ONCOLOGY ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:K
Authorized Official - Last Name:KIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-923-3876
Mailing Address - Street 1:2100 WEBSTER ST
Mailing Address - Street 2:SUITE 225
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2373
Mailing Address - Country:US
Mailing Address - Phone:415-923-3876
Mailing Address - Fax:415-923-3624
Practice Address - Street 1:2100 WEBSTER ST
Practice Address - Street 2:225
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2373
Practice Address - Country:US
Practice Address - Phone:415-923-3876
Practice Address - Fax:415-923-3624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASTATE LICENSEOtherG78339
CA1518155357OtherNPI
CASTATE LICENSEOtherC34434
CASTATE LICENSEOtherG72619
CA6124140001Medicare NSC